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Running head: NURS 710 PROJECT PROPOSAL 1

NURS 710 Project Proposal

Joel Vedders

Ferris State University

NURS 710 PROJECT PROPOSAL POSTING 3 2

Abstract

An increased commitment and process changes related to the care of the orthopaedic trauma

population at Spectrum Health in Grand Rapids, Michigan has resulted in acute compartment

syndrome developing into a low frequency, high risk event. Acute compartment syndrome is a

surgical emergency, and nurses play a key role in its recognition. The goal of this scholarly

project is to develop educational activities centered around the recognition and treatment of acute

compartment syndrome. This proposal outlines the development of these activities based on

adult learning theory. Methods for evaluation of this project are also discussed.

Key Words: acute compartment syndrome, evaluation, simulation, adult learning theory

NURS 710 PROJECT PROPOSAL 3

NURS 710 Project Proposal

Within the past decade a greater emphasis was placed on the care of the orthopedic

trauma patient population at Spectrum Health Butterworth in Grand Rapids, Michigan. As a

result of this increased commitment, an operating room (OR) dedicated solely to this population

was instituted. The ability to take a patient immediately from the emergency room to the OR

ensued. Prior to this, patients with complicated orthopedic injuries often waited on an inpatient

unit until an operating room was available. Consequently, nurses were frequently exposed to

complications related to these high energy injuries. One such complication is acute compartment

syndrome (ACS).

“Compartment syndrome occurs when pressure increases within a closed fascia space

that houses muscle, blood vessels, and nerves” (Schoenly, 2013, p. 204). Each group of muscles,

vessels, and nerves forms a compartment which is surrounded by a tough, fibrous, and inelastic

tissue called fascia (Wright, 2009). When pressure increases within this compartment from a

trauma such as a fracture, crush injury, or from external causes such as a bandages or casts that

are too tight, it can have devastating consequences. This can include muscle necrosis, permanent

nerve damage, and even amputation. (Fry, Wade, Smith, & Asensio-Gonzales, 2013).

Compartment syndrome is a surgical emergency, and nurses play a key role in identifying

its early signs and symptoms. The symptoms include pain, paresthesias, pressure, pallor,

paralysis, and pulselessness (Nation Association of Orthopaedic Nurses website, 2013).

Recently, a patient developed compartment syndrome on my unit that went unrecognized for a

number of hours. The patient exhibited signs of ACS, yet the nurse was so focused on

controlling the patient’s pain, the symptoms went unnoticed. Further complicating the case was


the patient’s history of chronic pain and high narcotic tolerance which made it difficult to obtain

an accurate assessment of the patient.

This event prompted a discussion centered around patient safety, it was determined that

although this was a complicated case, the dedicated orthopedic trauma room and the efficiency

with which it functions, has turned compartment syndrome into a low frequency high risk event.

Often, the patient will have had a fasciotomy prior to reaching the orthopaedic unit. Because

compartment syndrome has become less frequently observed on the inpatient unit, and the

devastating consequences it can have, an educational need has been identified. The purpose of

this paper is to outline my scholarly project proposal, which will involve designing a simulation

with the purpose of educating nursing staff on the identification and care of the patient with

compartment syndrome. The proposal will also include its setting, goals and objectives,

identification of a preceptor, timeline of the proposed project, in addition to agency approval.

Goals and Objectives and Activities

The project will be developed in accordance with the recommendations for practice

guidelines of the National Association of Orthopaedic Nurses (NAON). To this end, two goals

have been identified for this scholarly project. The first, as outlined in the proposal planning

guide (see Appendix A), is to create an outline for the development of educational activities for

orthopaedic staff at Spectrum Health. The second goal will be to create educational activities,

with the intent of having them ready to implement in July of 2014.

In order to achieve the above stated goals, several objectives will be formulated as a

guide to successfully complete the scholarly project. First, it will be important to evaluate the

current educational material offered at Spectrum Health related to ACS. Doing this will allow

for identification of strengths in the curriculum, and also find potential gaps where additional


content could be added. In order to accomplish this, I plan to attend the orthopaedic core class

offered at Spectrum Health. The core class is attended by employees newly hired into the

orthopaedic units at both Spectrum Health Butterworth and Blodgett campuses. Doing this will

allow me to hear the content first hand to become more familiar with the material, as well as

make notes related to potential curricular shortcomings. Additionally, it will be important to

meet with the current orthopaedic educators and clinical nurse specialist (CNS) to review current

teaching materials to determine where potential changes could be made. Conducting a needs

assessment with orthopaedic leadership as well as educators will also assist in further uncovering

potential gaps in ACS education.

Once potential strengths and weaknesses within the current orthopaedic education have

been recognized, it will be important to identify topics to included in the educational activities.

NAON’s core curriculum for orthopaedic nursing will be used as a guide to ensure proper

nursing considerations are addressed. Databases such as Clinical Key, Cinahl, and PubMed will

be utilized to obtain current literature, in addition to resources found in the bibliography, to

further clarify pertinent topics to cover in the educational offering. An additional activity will be

to meet with the orthopaedic trauma surgeons to receive input regarding key points to address

related to ACS.

As new material is added to the current orthopaedic curriculum it will be important to

incorporate adult learning theory into the development of the educational activities. “Learning

theories and frameworks provide the structure that guides the selection of learning activities”

(Billings & Halstead, 2009, p. 192). Reviewing literature related to adult theory will be an

important activity as this project takes shape, specifically as it relates to Malcolm Knowles

principles of adult learning, as this was chosen as one of the foundational theories for this


proposal. An additional activity will be to review literature related to different teaching

strategies that can be used while implementing the scholarly project. This can be done under the

guidance of my preceptor.

The second goal's objectives will allow for implementation of the scholarly project in

July, 2014. First, a simulation will be developed. Using a simulation template will be the main

activity associated in creating a quality simulation. Templates often include the scenario's title,

focus area, scenario description, objectives, equipment needed, essential resources, simulator

level, participant description, required student actions, instructor interventions, and evaluation

(Campbell and Daley, 2009). Second, PowerPoint slides will be developed based on the

literature research and input from physicians, educators, leadership, and my preceptor. These

two activities will be incorporated into Spectrum Health’s current orthopaedic core class. Using

these two teaching strategies allows for the content to be addressed in two different styles.

Simulation allows the learner to be actively involved in the activity, and has many

advantages. It provides immediate feedback, and allows the learner to apply their knowledge in

a mistake free environment, increases interdisciplinary teamwork skills, and improves critical

thinking (Nehring & Lashley, 2010). The PowerPoint will be used to clarify any content within

the simulation that may have been confusing, and to ensure all key concepts of ACS were

covered. According to Billings and Halstead (2009), students learn in a variety of ways so it is

very important to incorporate activities that stimulate all learners. Using simulation, in addition

to a PowerPoint presentation will be an effective way to present the material.

Evaluation

The final objective will be to evaluate the effectiveness of the simulation and PowerPoint

presentation, in addition to assessing whether the goals for the scholarly project have been met.


An evaluation tool will be created to distribute to the participants in the educational activity. The

tool will utilize a series of questions with the incorporation of the Likert Scale (Appendix B).

The questions will seek information from the learners related to perceived knowledge before and

after the activity, in addition to the effectiveness of the instructor and the value of the material

taught. The evaluation tool will also provide an opportunity for the learner to offer feedback

related to areas which need improvements. This evaluation tool will provide valuable

information which will allow for program improvement.

A second activity will be to create an evaluation tool for my preceptor to complete

(Appendix C). This tool will allow the preceptor to judge the overall effectiveness of the

scholarly project. There will be an opportunity for my preceptor to provide a brief narrative,

where constructive feedback can be given. This feedback will aid in my professional

development as an educator and provide information for areas of potential growth.

Dates and Timelines

This project will take place during the summer semester of 2014. The tentative dates can

be found within the project proposal planning guide (refer to appendix A). Resources for the

scholarly project will be gathered throughout the spring semester 2014 as the proposal is being

formed. The intent is to begin creating the educational activity in mid-May 2014, with the goal

of having the learning activities ready to present by mid-July, 2014.

Foundational Theory

"Effective education of adults through simulation requires a sound understanding of adult

learning theory" (Zigmont, Kappus, & Sudikoff, 2011, p. 47). Since the goal of the scholarly

project is to develop and implement learning activities in the form of a simulation and

PowerPoint presentation it seemed appropriate to use a combination of two theories. Malcolm


Knowles’ Principles of Adult Learning, in addition to Kolb's Experiential Learning Theory

(ELT). Knowles used guiding principles related to the design and implementation of adult

learning. First he believed that a person’s experiences form a platform for potential learning

activities (Vandeveer, 2009). Second, adults want to learn information that is relevant to them

whether that be in their personal life or their job. Third, the learning activities must be problem-

centered. It is important to design the training in such a way that it is as close to what the learner

would experience in the work environment. (Vandeveer, 2009).

Kolb's ELT will assist in the development of the simulation. Experiential learning has

the student directly involved in the learning activity. There are four different aspects of ELT

which include active experimentation, concrete experience, reflective observation, and abstract

conceptualization (Jeffries, Clochesy, & Hovancsek, 2009). Kolb's theory is "linked directly

with simulation and can guarantee a clinical event (concrete experience), reflection (debriefing),

conceptualization (reviewing and understanding), and experimentation (learning on the

simulator)", (Waxman & Telles, 2009, p. 232). A low frequency high risk event such as ACS is

not always seen while a nurse is in orientation or as a student in nursing school. In the absence

of " real" clinical experiences, simulation assists the learner to move from knowledge, to

application of this knowledge in the clinical setting (Zigmont et al., 2011). Developing a

simulation with these guiding principles as the foundation will assist in the development of the

learning activities, especially as it relates to simulation.

Practicum Setting

My practicum will take place at the Cook Institute simulation lab at Spectrum Health

Butterworth Hospital in Grand Rapids, Michigan. A copy of the student/agency agreement can

be found in Appendix D. Spectrum Health Butterworth is the only Level 1 Trauma center in the


Grand Rapids area. It is part of a much larger health system comprised of multiple hospitals,

outpatient and urgent care centers, extended care facilities, and a dedicated children's hospital

and cancer pavilion. Spectrum Health has used simulation in a variety of settings including

medical surgical, pediatrics, surgical services, and the emergency departments for several years.

Wang (2011) reported that the medical community has embraced simulation because of its

importance in improving patient safety and clinical training. According to Berndt (2010),

simulated clinical experiences positively affect critical thinking, competency levels, and skill

acquisition. Spectrum Health is committed to simulation as a way of providing training in a safe

non-threatening environment.

The simulation lab is 2200 square feet and consists of three large simulation rooms which

are all designed to mimic a real hospital room, creating a very realistic clinical environment. The

largest room is equipped with audio and video capabilities allowing the instructor to speak to the

staff during the simulation and also enabling the simulation scenarios to be recorded. The

simulation lab is also equipped with a staging area where supplies are kept in order to set up a

variety of simulations. There is also a media booth with one-way glass where the high-fidelity

simulators are controlled allowing the simulation to be observed while not being a distraction.

The simulation rooms are not used only for high-fidelity simulation, but for task training with

low simulation mannequins as well. The final room is the debriefing room where the class can

meet once the scenario is completed. This room is equipped with a large monitor where the

simulation can be reviewed. "Participating in simulation provides the hands-on learning, but the

facilitated debriefing is where the cognitive processes that lead to long-term learning and

application occur" (Nehring & Lashley, 2010, p. 370). This new simulation lab has included all


of the necessary elements in providing an excellent learning experience for staff and is the

perfect venue to carry out the learning activities.

Preceptor

An experienced preceptor is able to identify learning opportunities and serve as a guide

in helping the student with goal achievement. Selection of a preceptor is therefore very

important, and is key to the success of my scholarly project. There are certain characteristics

preceptors must possess. "A preceptor is an individual with demonstrated competence in a

specific area who serves as a teacher/coach, leader/influencer, facilitator, evaluator, socialization

agent, protector, and role model to develop and validate the competencies of another individual"

(Ulrich, 2012, p. 1). In addition to these characteristics it is also important for the preceptor to be

an expert in the selected content you wish to learn. Since the focus of my scholarly project will

involve development of a simulation, choosing a preceptor with expertise in this arena is

important.

My preceptor for the scholarly project will be Vickie Slot MSN, RN. A copy of the

student/preceptor contract can be found in Appendix E. Mrs. Slot attended Calvin College prior

to attending Grand Valley State University (GVSU), where she graduated with honors with her

BSN degree. She then returned to GVSU from 2003-2006 where she received her Master of

Science in nursing (MSN) with an education focus. Her experience in simulation is extensive.

While in graduate school her projects were directed toward simulated learning. Mrs. Slot was

also instrumental in the design, development, and implementation of the first high fidelity

simulation at Hope College, where she was director of nursing laboratories for five years. In

addition, Mrs. Slot was also certified in simulation instructional methods in 2001, and has

attended several simulation related conferences, classes, and workshops which keeps her current


in the ever changing world of simulation. Her most recent conference attendance was in San

Francisco in late January, 2014 where she earned her certification as a healthcare simulation

educator.

In addition to her experience in simulation, Mrs. Slot also has experience teaching.

These experiences include teaching introductory and advanced nursing skills classes at Hope

College, adjunct faculty at GVSU from 2001-2005, and was also an instructor in the LPN

program for Olympia Career Training Institute. Currently, Mrs. Slot is a simulation nurse

educator at Spectrum Health. She has worked in this capacity since 2011. Her expertise in

simulation allows her to participate in strategic planning and development in simulation

programming and curriculum. Vickie's teaching experience, in addition to her extensive

knowledge in simulation, are a great combination which makes her an excellent choice as my

preceptor for my scholarly project.

Conclusion

Beginning in May of 2014, the development of this scholarly project will start. The goal

of this project is to create educational activities for the orthopaedic staff at Spectrum Health

related to the care of the patient with ACS. Activities such as a PowerPoint and simulation will

be created using evidence based information in accordance with NAON standards and Spectrum

Health's policies. The activities will be formed using concepts of adult learning theory. The

completed scholarly project will be ready for delivery by mid-July, 2014.


References

Berndt, J. (2010). The ethics of simulated nursing clinical experiences. Teaching and Learning in

Nursing, 5, 160-163. http://dx.doi.org/10.1016/j.teln.2010.03.004

Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St

Louis, MO: Saunders Elsevier.

Fry, W. R., Wade, M. D., Smith, R. S., & Asensio-Gonzales, J. A. (2013). Extremity

compartment syndrome and fasciotomy: a literature review. European Journal of Trauma

Emergency Surgery, 39, 561-567. http://dx.doi.org/10.1007/s00068-013-0329-8

Jeffries, P., Clochesy, J. M., & Hovancsek, M. T. (2009). Designing, implementing, and

evaluating simulations in nursing education. In D. M. Billings, & J. A. Halstead (Eds.),

Teaching in nursing: A guide for faculty (3rd ed., pp. 322-334). St. Louis, MO: Saunders

Elsevier.

National Association of Orthopaedic Nurses website. (2013). http://www.orthonurse.org/

Nehring, W. M., & Lashley, F. R. (Eds.). (2010). High-fidelity patient simulation in nursing

education. Sudbury, MA: Jones and Bartlett Publishers.

Schoenly, L. (Ed.). (2013). Core curriculum for orthopaedic nursing (7th ed.). Chicago, IL:

National Association of Orthopaedic Nurses.

Ulrich, B. (Ed.). (2012). Mastering precepting: A nurse’s handbook for success ( ed.)

Indianapolis, IN: Sigma Theta Tau International

Vandeveer, M. (2009). From teaching to learning: Theoretical foundations. In D. M. Billings, &

J. A. Halstead (Eds.), Teaching in nursing a guide for faculty (3rd ed., pp. 189-226). St.



Wang, E. E. (2011, November). Simulation and adult learning. Disease a Month, 57, 664-678.

http://dx.doi.org/10.1016/j.disamonth.2011.08.017

Waxman, K. T., & Telles, C. L. (2009). The use of Benner’s framework in high fidelity

simulation faculty development: the bay area simulation collaborative model. Clinical

Simulation in Nursing, 5(6), e231-e235. http://dx.doi.org/10.1016/j.ecns.2009.06.001

Wright, E. (2009). Neurovascular impairment and compartment syndrome. Paediatric Nursing,

21(3), 26-29.

Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). Theoretical foundations of learning

through simulation. Seminars in Perinatology, 35, 47-51.

http://dx.doi.org/10.1053/j.semperi.2011.01.002


Appendix A

NURS 710 Project Proposal Planning Guide

Project purpose: The purpose of this paper is to outline my scholarly project proposal, which

will involve designing a simulation with the purpose of educating nursing staff on the

identification and care of the patient with compartment syndrome.

Goals Objectives Activities Timeline

Goal 1:

Create a framework for

the development of

educational activities

for orthopaedic staff at

Spectrum Health

related to the care of

the patient with acute

compartment syndrome

(ACS).

1.1

Identify current

strengths and

weaknesses in current

ACS education at

Spectrum Health

1.1

a.) Attend orthopaedic

core class currently

offered at Spectrum

Health to assess

information being

taught related to ACS

and pain management

b.) Meet with current

orthopaedic educators

and clinical nurse

specialist (CNS) to

review current

teaching materials.

1.1

a.) To be completed

by June 1, 2014

b.) To be completed

by June 1, 2014


1.2

Identify material to be

included within the


c.) Conduct a needs

assessment with

managers, leadership,

and orthopaedic

educators.

1.2

a.) Search Clinical

Key, Cinahl, and

Pubmed for literature

related to ACS.

b.) Meet with

orthopaedic trauma

physicians to

determine key

teaching points

related to ACS to be

included in the

learning activities

c.) To be completed

by June 1, 2014

1.2

a.) To be completed

by June 10, 2014

b.) To be completed

by June 10, 2014


1.3

Incorporate adult

learning theory and

principles into the

development of the


1.3

a.) Review literature

related to Malcolm

Knowles principles of

adult learning theory.

b.) Review the

literature related to

different teaching

strategies that can be

utilized.

c.) Determine

teaching strategies

and content to be used

within the learning

activities using the

guidance and

expertise of my

preceptor.

1.3

a.) To be completed

by June 15, 2014

b.) To be completed

by June 15, 2014

c.) To be completed

by June 15, 2014


Goal 2:

Complete the creation

of the educational

activities and have

them ready for

implementation in July

of 2014.

2.1

Develop a simulation

and PowerPoint to be

incorporated into

Spectrum Health’s

current orthopaedic

core class using a

variety of teaching

strategies

2.1

a.) Write simulation,

including outline and

objectives, using

simulation template

provided by my

preceptor.

b.) Develop

PowerPoint slides for

presentation of

learning material.

c.) Incorporate

simulation and

PowerPoint into

orthopaedic core class

2.1

a.) To be completed

by July 10, 2014

b.) To be completed

by July 10, 2014

2.2 To be completed

by July 17, 2014


2.2

Evaluate the

effectiveness of the

simulation, and self-

evaluation of the

attainment of the

goals of the scholarly

project.

2.2

a.) Create and

evaluation form for

use by my preceptor

to determine if

scholarly project

goals and objectives

were met.

b.) Create an

evaluation tool for

staff to complete

following learning

activities.

2.2

a.) To be completed

by July 17, 2014

b.) To be completed

by July 17, 2014


Appendix B

Educational Activity Evaluation Tool

Key: 1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agree

Please follow the above key and respond to each statement by circling a number.

1. The instructor was knowledgeable about the material presented. 1 2 3 4

2. The instructor demonstrated effective communication skills. 1 2 3 4

3. The instructor implemented teaching strategies appropriate to meet

the needs of the staff. 1 2 3 4

4. The educational offering increased my understanding of acute

compartment syndrome. 1 2 3 4

5. The content can be easily applied to practice. 1 2 3 4

6. The physical environment was conducive to learning. 1 2 3 4

Please provide comments below which you think would make this learning activity more

effective:


Appendix C

Preceptor Evaluation Tool

Listed below are our agreed upon goals and objectives for the clinical project. Please review each of the objectives listed in the far left hand column. Once these objectives have been reviewed, place an “X” in the appropriate box next to the corresponding objective, verifying whether the objective was “met” or “unmet” by the student. Next, provide comments in each box in the far right column explaining how each objective was met, or offer suggestions for improvement. Finally, provide any additional comments/feedback for student improvement that you may have in the bottom feedback section provided.

Goal 1: Create a framework for the development of educational activities for orthopaedic staff at Spectrum Health related to the care of the patient with acute compartment syndrome (ACS).

Objective Objective Met Objective Unmet Comments 1.1: : Identify current strengths and weaknesses in current ACS education at Spectrum Health1.2: Identify material to be included within the educational activities1.3: Incorporate adult learning theory and principles into the development of the educational activities

Additional Preceptor Feedback


Goal 2: Complete the creation of the educational activities and have them ready for implementation in July of 2014.

Objective Met Unmet Comments

2.1: Develop a simulation and PowerPoint to be incorporated into Spectrum Health’s current orthopaedic core class using a variety of teaching strategies

2.2: Evaluate the effectiveness of the simulation, and self-evaluation of the attainment of the goals of the scholarly project.

Additional Preceptor Feedback:


Appendix D


Appendix E


Bibliography

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J. A. Halstead (Eds.), Teaching in nursing a guide for faculty (3rd ed., pp. 189-226). St.


Wang, E. E. (2011, November). Simulation and adult learning. Disease a Month, 57, 664-678.

http://dx.doi.org/10.1016/j.disamonth.2011.08.017

Waxman, K. T., & Telles, C. L. (2009). The use of Benner’s framework in high fidelity

simulation faculty development: the bay area simulation collaborative model. Clinical

Simulation in Nursing, 5(6), e231-e235. http://dx.doi.org/10.1016/j.ecns.2009.06.001

Wright, E. (2009). Neurovascular impairment and compartment syndrome. Paediatric Nursing,

21(3), 26-29.

Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). Theoretical foundations of learning

through simulation. Seminars in Perinatology, 35, 47-51.

http://dx.doi.org/10.1053/j.semperi.2011.01.002

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