實施基于案例的學習來培養臨床判斷技能.pdf

1、Learner Disclosures1 Provider Statement:Assessment Technologies Institute,LLC(ATI Nursing Education)is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Centers Commission on Accreditation Criteria for Successful Completion:To obtain credit

2、for this activity,the participants must:Attend 100%of the session Complete activity by 07/31/2023 and submit the online evaluationExpires 7/31/20232 All information included in National Nurse Educator Summit presentations is the copyrighted property of ATI or the individual presenters.You may not re

3、cord this presentation or copy and/or distribute any of the handout materials.Implementing Case-Based Learning to Develop Clinical Judgment SkillsBev Wilgenbusch,EdD,MSN,RN,CNE,CCRNMiami University-Hamilton,OHWelcome!Learning OutcomesDiscuss and Analyze Inquiry Based Learning(IBL)options and their a

4、pplicationDevelop deeper understanding of Case Based Learning(CBL)Identify applications of CBL to clinical judgment(CJ)Relate role of Instructors Guide in CBL strategiesEvaluate and select Cases for CBL and CJDevelop an Instructors GuideLets Find Out Where We Arehttps:/app.sli.do/event/7LPNWLumjE3Ly

5、1e5NznwPw6This Photo by Unknown Author is licensed under CC BY-SA-NCInquiry Based Learning(IBL)Also known as Inquiry Based Instruction(IBI)Variable definitions Can be umbrella term Active,reflective strategies where students explore resources to better understand,solve,demonstrate or apply learning

6、Can include:Problem-based learning(PBL)Project-based learning(PjBL)Case-based learning(CBL)Team-based learning(TBL)SimulationWhy IBL?8Cultivates student engagementEncourages application versus retentionSupports inquiry-searching for answersFosters making meaningFacilitates teamworkIBL-Which strategy

7、 should I use?9Multiple answers are acceptable to address a problemPBLAn actionable goal needs to be metPjBLA specific scenario has defined outcomes/expectationsCBLFosters collaboration within a specific topicTBLExperience defined skills,behaviors and/or attitudesSimulationHow Do You Feel About CBLh

8、ttps:/app.sli.do/event/gN2oAg54nXBMChv3Giuu8h10This Photo by Unknown Author is licensed under CC BY-SA-NCCase-Based Learning(CBL)Variety of Approaches Simple Case focused on knowledge More Complex Case focused on knowledge with some application Unfolding Case focused on multiple objectives“True”CBL

9、Collaborative Learning Exploration of Resources Application of knowledge to notice,interpret and respond Reflection Most of ususe a hybrid approachStructure of“True”CBL12Reputable ResourcesPre-Work(Pre-Assignments)Case Selection to Meet ObjectivesCase PartsSmall Group WorkInstructor as FacilitatorRo

10、le of Assessment(Formative/Summative)Importance of ReflectionGoalsStudents PrepareEvaluate CaseGroup Work-Learn from Each OtherFacilitate DiscussionReflect13A Side Note About Assessment With the new essentials,CBL may be an opportunity to infer clinical reasoning May want to consider Formative asses

11、sment(use of CBL to foster learning in small groups)Summative assessments Testing Competency assessment Link to simulation activities NGN questions14This Photo by Unknown Author is licensed under CC BY-NC-NDDesigning CBL to Impact Clinical Judgment15Case Selection Is ImportantDesign of Case Question

12、 Format/FocusIntentional Use of LanguageFocus on Reasoning and Action versus KnowledgeSelecting Your Case Decide case length Timeframe,Population,Space History and Data relate to course objectives Focus discussion questions on clinical judgment and be consistent Tanners Clinical Judgment Model/Lasat

13、ers Clinical Judgment Rubric Noticing,Interpreting,Responding,Reflecting Nursing Process Assessment,Diagnosis,Planning,Implementation,Evaluation Clinical Judgment Measurement Model Noticing Cues,Analyzing CuesSelect Your Case-Case Length17Timeframe Completing in one class time Utilizing case over mu

14、ltiple sessions Hope to complete in 30-60 minutesPopulation Number of students Goal of keeping small groups to 2-3Space Ideally:Open areas with tables that can accommodate 2-4 peopleSelecting Your Case-Case History and Data18Match Case to Objectives of Learning SessionStay Focused on these Objective

15、sRelate Data to Actual PracticeData Consists of:Relevant HistoryCurrent SymptomsAssessmentLabs,Imaging,TestsSelect Your Case-Discussion Questions Questions are easily traced to model terms Use the terms you feel most comfortable with-just be consistent Intentionally use these terms in questions What

16、 did you notice?How did you interpret that?How would you respond?When reflecting,what did you value?19Instructor Guide20This Photo by Unknown Author is licensed under CC BY-NDWhy Create an Instructors Guide?21ConsistencyShareabilityTime ManagementReproducibility over timeLets Look at the Instructors

17、 Guide Template22Intentional designCan adapt to your case and objectivesQuestion format uses Tanners Clinical Judgment ModelCan use for multiple cases,multiple parts of a case,unfolding casesIncludes:Application of knowledge Selection of interventions Evaluation of outcomes Reflection on learningIns

18、tructors Guide TemplateInstructors Guide Case Based Learning(CBL)and Clinical Judgment(CJ)TemplateCase:Title of CaseCASE OVERVIEWThis instructors guide is designed for a 2-case CBL intervention during an in-person learning session in a nursing course designed to foster clinical judgment skills.Brief

19、 Description of Case:Briefly describe the scenarioParticipant Activities:Participants will need to review relevant information to identify potential problems as well as appropriate collaborative(medical and nursing)interventions for the client(s)in the case.Relevant information is in the form of ide

20、ntified resources provided by the instructor/facilitator.Pre-Intervention Activities:In preparation for this intervention,participants will be asked to complete a preparatory assignment with identified resources provided by the instructor/facilitator.Instructor/Facilitator Guidelines:For each case,t

21、he instructor will provide an outline of how participants will progress through the tasks.The instructor will ask participants to form small groups of 2-3,where they will review the information provided about the case and answer the questions that correspond to each part(Part I or II)of the case.The

22、 instructor will ask participants to begin with Part I,providing approximately 10 minutes for participants to complete the questions in Part I.After this task is completed,the instructor will lead a debriefing of each part addressing the objectives below.The debriefing is scheduled to last approxima

23、tely 15 minutes,after which participants will be directed to Part II and repeat the process.The last question in Part II of each case is a reflective question,designed to be answered as the last component of the reflection discussion activities.The questions for each objective can be applied to both

24、 cases,as the objectives for each case are the same.Answers may vary depending on each clients situation,but the guide is applicable to both clients.CASE OBJECTIVES After analyzing and discussing this case,undergraduate nursing students will be able to:Describe pathophysiology,etiology,and risk fact

25、ors of Consider collaborative interventions of importance to a client with Implement therapeutic communication skills to address any educational needs of the client.Reflect on decision making strategies used to guide the clients care.Instructors Guide Template24DEBRIEFING GUIDELINES Objective#1:Desc

26、ribe pathophysiology,etiology,and risk factors of Participants will be asked to complete the questions in Part I of the case in small groups.Part I of the case provides data regarding the clients history and initial laboratory results.The questions specifically address symptoms related to the pathop

27、hysiology of,as well as possible etiologies related to each clients history,and potential risk factors.When the small groups complete the tasks in Part I,ask them to return to the larger group for intentional reflection and discussion.In facilitating this discussion,the instructor will guide student

28、s in examining how their responses correlate to the objectives.The instructor can intentionally identify how the following questions relate to steps in the clinical judgment model,as noted in parentheses after each question.Use the following questions(or the questions from your case)to guide the dis

29、cussion to correlate the questions in Part I to this objective:What data did you notice that affects the clients current health and may be helpful in diagnosis?Noticing/Assessing/Identifying CuesAre any of these symptoms more important than others?Noticing/Analyzing CuesAre any of the lab values rel

30、evant to the clients problems?Why?Noticing/Interpreting/Analyzing CuesIs there any additional data you would find helpful?Why?Noticing/Analyzing CuesAre there any data points that can be identified as risk factors for specific disease processes?Interpreting/Analyzing CuesAfter the discussion for Par

31、t I is complete,ask participants to meet again in their small subgroups to complete Part II.Allow approximately 10-15 minutes to complete the questions in Part II,and then ask them to return to the larger group for another intentional reflection and discussion session.At this point,the instructor wi

32、ll guide participants in examining how their responses correlate to the objectives.Again,the instructor can intentionally identify how the following questions relate to the steps in the clinical judgment model,as noted in parentheses after each question.Use the following questions to guide the discu

33、ssion to correlate the discussion to this objective:Why do we need to know about the clients assessment/history?Interpreting/Analyzing CuesHow would you explain the hypothesis/diagnosis to the client?Interpreting/Prioritizing Hypotheses,Responding/Generating SolutionsWhat medical diagnoses did you c

34、onsider for the client?Why?Interpreting/Prioritizing HypothesesWhat nursing diagnoses would be important for the client?Why?Interpreting/Prioritizing HypothesesInstructors Guide Template25Objective#2:Consider collaborative interventions of importance to a client with During the Part II intentional r

35、eflection and discussion timeframe,the instructor will continue to encourage participants to link case material to each objective.When identifying how collaborative interventions would support the clients health needs,keep in mind that there are a wide range of interventions of possible benefit to t

36、he client.It will be important to focus on what may be most relevant for the client at this time.Use the following questions to help participants identify interventions most relevant to Jorge right now:What collaborative interventions would help meet the clients immediate needs?Why?Responding/Genera

37、ting Solutions/Take ActionsWhat collaborative interventions would help you respond to the clients long-term needs?Why?Responding/Generating Solutions/Take ActionsWhat intervention would be considered as the most important response?Why?Responding/Prioritizing Solutions/Take ActionsBased on your inter

38、pretation,how would you prioritize interventions on a need versus want scale to best respond to the client?Interpreting,Responding/Prioritizing Solutions/Take ActionsBased on your interpretation,are there any interventions for this client not relevant at this time?Why?Interpreting/Generating Solutio

39、nsWhat interventions can minimize long-term complications?Interpreting,Responding/Generating Solutions/Take ActionsHow would you know if the interventions improved the clients situation?Reflecting/Evaluating OutcomesObjective#3:Implement therapeutic communication skills to address any educational ne

40、eds of the clientDuring the discussion for Part II,specifically focus on therapeutic communication skills in potential conversations with the client.It is important to encourage participants to think about how stressful new medical diagnoses can be for clients to manage.Therapeutic communication ski

41、lls are a valuable set of skills using throughout nursing practice.Repetition and role playing may be considered here if time allows.Use the following questions to assist participants in selecting therapeutic communication choices in potential conversations with the client:How would you tailor your

42、response to this client?Responding/Take ActionsWhat would you consider the priority educational response for the client?Why?Responding/Prioritizing SolutionsIf you could only share two pieces of education with the client today,what would they be?Why?Responding/Prioritizing Solutions/Take ActionsWhat

43、 communication tools would you think best for the client today?Responding/Generating SolutionsHow would you follow-up with the client?Responding/Take Actions/Evaluate OutcomesWho might you consider adding to the clients treatment team?Why?Responding/Generating SolutionsInstructors Guide Template26Ob

44、jective#4:Reflect on decision making strategies used to guide the clients careTo meet this objective,participants will complete the following questions as the last step of the reflection discussion.Allow participants to spend an appropriate amount of time to individually answer these questions.Encou

45、rage students to reflect on their learning,and how they can apply the practices implemented in the case to other cases.A discussion would be encouraged,but individual growth may be personal and more reflective if confidential.When opening a discussion,try to utilize clinical judgment model terms men

46、tioned throughout the guide.The instructor can encourage students to review their reflection at a later point in time to identify areas of growth through the program.Reflecting/Evaluate OutcomesReflect on your work with the client and answer the following questions:What was your biggest success when

47、 working through this case?What was the area you felt you could develop more when responding to a client with similar concerns?What is one thing you will do differently after participating in this process?How can you improve your ability to notice and interpret cues,respond,and evaluate your actions

48、 with clients?Now Lets Practice!Lets Look at a Case and related Instructors Guide28Compare the Case to the Guide Case and Guide samples available on Summit websiteCompareLook at your Case and work off the Instructors Guide templateLookIdentify objectives firstIdentifyReview questions-Be intentional

49、about clinical judgment terms Questions should reflect both clinical judgment skills and case objectivesReviewSummary29CBL can be designed to enhance clinical judgment skillsAn instructors guide enhances consistency,reproducibility and time managementClarify your constraints,objectives,and termsCan

50、be a valuable tool in your educational toolboxContact Information Feel free to reach out with any questions,comments,feedbackBev Wilgenbusch,EdD,MSN,RN,CNEAssistant ProfessorMiami University Hamilton,OHwilgenbamiamioh.edu513-617-173330Questions Feedback Comments Idea Sharing31This Photo by Unknown A

51、uthor is licensed under CC BYReferencesDickison P,Haerling KA,Lasater K.(2019).Integrating the National Council of State Boards of Nursing Clinical Judgment Model Into Nursing Educational Frameworks.Journal of Nursing Education,58(2):72-78.https:/doi.org/10.3928/01484834-20190122-03Ertmer,P.A.,Quinn

52、,J.A.,and Glazewski,K.D.(2019).The ID casebook(5thed.).Routledge.Jacob,S.A.,Dhing,O.H.,and Malone,D.(2019).Perceptions of Australian and Malaysian educators in an undergraduate pharmacy program on case-based learning.American Journal of Pharmaceutical Education,83(3),Article 6597,p.401-411.Li S,Ye X

53、,Chen W.(2019).Practice and effectiveness of“nursing case-based learning”course on nursing students critical thinking ability:A comparative study.Nurse Education in Practice,36(1):91-96.Accessed November 25,2022.https:/search-ebscohost-com.proxy.lib.miamioh.edu/login.aspx?direct=true&db=eoah&AN=4933

54、5109&site=ehost-live&scope=sitePiper,B.,Zuilkowski,S.S.,Dubeck,M.,Jepkemei,E.,and King,S.J.(2018).Identifying the essential ingredients to literacy and numeracy improvement:Teacher professional development and coaching,student textbooks,and structured teachers guides.World Development,106,p.324-336.https:/doi.org/10.1016/j.worlddev.2018.011.018Walker,A.,Leary,H.,Hmelo-Silver,C.E.,&Ertmer,P.A.(2015).Essential readings in problem-based learning:Exploring and extending the legacy of Howard S.Barrows.Purdue University Press.