Curriculum Development Paper

Identification of the educational need and rationale.
Prevention is better than the cure, medical technology and development of hospitals as the focus of health care practice. The CDC estimated a total of 1.7 million patients in the hospital that gets a nosocomial infection and 99,000 will die from the infection. This results to one patient death in every five minutes, hospitalized patients Hospital acquired pneumonia is currently the second most common nosocomial infection in the United States and is associated with high mortality and morbidity (Seymann, 2008). Higher rates of hospital-acquired pneumonia (HAP), functional decline, pressure ulcers, and falls are a few factors that leads to prolonged bed-rest . HAP Iis a pneumonia that begins within 48 hours after hospitalization and does not incubate at the time of admission. Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired pneumonia (Seymann, 2008). Those at risk include patients with a compromised immune system, are HIV positive, have been hospitalized for more than two days, reside in a nursing home, have COPD, diabetes, heart failure, are elderly, alcoholics or have other underlying disorders (Smeltzer, et al). A new report regarding the high death rate due to hospital acquired pneumonia was a an issue that could not be ignored by congress in light of the fact that it was published days before President Barack Obama convened a Health Care Summit in Washington last week (Zigmond, 2010).
Goals/learner outcomes for the lesson.
One of the main educational needs determined in the hospital is infection control. According to the U.S. National Library of Medicine National Institutes of Health (2011) “infectious diseases kill more people worldwide than any other single cause” (para. 1).The goal of this educational module is to improve the nurses’ knowledge of preventing hospital acquired pneumonia and to improve early recognition of early symptoms, to decrease the number of hospital acquired cases of pneumonia, and improve the outcomes of patients. Elderly patients who are admitted in the hospital are at higher risk of functional decline. Quality improvement measures will be determined, through utilization of improvement tools, utilizing change theory, visual displays and models to emphasize the benefits of policies and procedures in ambulation on a medical-surgical unit.
The learning objectives
The nursing staff will be able to standardize and implement the Hospital Acquired Pneumonia Prevention protocol in the medical-surgical unit to improve optimal outcome. Upon completion of this lesson, the student will:
1. Describe the key aspects of the HAP Prevention protocol.
2. The nursing staff will be able to standardize and implement HAP prevention protocol to at-risk patients to improve optimal outcome.
3. Describe and understand the standardized order sets and clinical pathway.
5. Discuss the importance of identifying goals and setting priorities.
6. Describe strategies of effective verbal and written communication skills.
Learning Theory
Change is inevitable whether we want it or not, still, the process of implementing change is challenging. Nurses already overwhelmed by change may not have the required energy to make yet more. (Dulaney & Stanley, 2005). The change theory of Kurt Lewin delivers a clear and linear pathway for a quality initiative. There are three stages in Lewin’s theory which shows the process of “unfreezing” this stage includes removing the status quo and lead such behaviors to a readiness for change (Mitchell, 2013). In this stage resistance to change is often met and the key stakeholders of initiating the change were identified. The moving stage includes the process of changing feelings, thoughts, and behaviors of the team. It is during this phase that people begin to have doubts and will want to move back to their previous levels of comfort, it is important then, to be supportive and reinforce the learning from phase one. (Dulaney & Stanley, 2005).
Key players of change initiation are also identified. Resistance to change is often met in this stage, therefore, motivational factors need to be implemented in order to move the process forward. The “moving” stage involves the process of changing of thoughts, feelings, and behaviors of the team. Sufficient support and training “moving” stage will help attain a new comfort zone. Sufficient education, team involvement, and information is vital during this stage to ensure a successful implementation of early ambulation initiatives. The “refreezing” is the final stage which the successful integration of change was integrated into practice. It is important in this stage to reinforce education, and continuous monitoring of outcomes, it is a continuous effort is needed to prevent old habits from returning. It is significant to reward and reinforce the positive outcomes. The change agent (the person who implements the change) plays a large role in influencing the staff that is affected by the change. (Timmins, 2008).
Completion of content outline.
The HAP prevention protocol will be implemented in two phases: 1. Phase I ( September – October 2014) a. Provide education for all the staff on the HAP Prevention Protocol b. Develop the HAP prevention documents: c. Standardized framework for HAP prevention: The Route Bundle d. Clinical nursing Pathway e. Patient education materials f. Poster project timeline and highlight progress g. Visual aids for staff education 2. Phase II November 2014 a. All units “up” and trained, and coached of process measures b. Review staff compliance with all HAP prevention components c. Measure patient outcomes within 30 days evidenced by 50% patients ambulated twice daily. d. Reduction of HAP incidences by December 2014 and 40% by December 2015.
Content Outline:
1. HAP Prevention Protocol a. What is HAP Prevention? b. HAP Prevention Protocol Framework c. Metrics d. Electronic Medical Records (EMR) documentation
2. Methods a. HAP Prevention b. An End-to-End Intervention c. POM (Peri-Op Medicine) Clinic d. Pre-op Day of Surgery /PACU/Post Surgery e. Admission to Unit f. Throughout Stay
3. HAP Route Bundle a. R- Respiratory Care b. O-Oral Care c. U- Up d. T- Tube Care e. E- Eucation 4. The Med-Surg Workflow Schematic a. Clinical Focus b. Impact c. Measures d. Documentation 5. Measures a. HAP Outcomes b. Mobiltiy Protocol Implementation c. Documentation I. Oral Care II. Mobility III. Tube Care
Instructional methods to be used for delivery.
A flowchart will be used to categorize the patients who are at risk of deconditioning because of prolonged bed rest. The flow chart will show a visual of multifaceted processes to better understand the improvement ideas, and practice issues. in order to have a better understanding of the practice issue, precipitating improvement ideas. It helps team members gain a shared understanding of the process and use this knowledge to collect data, identify problems, focus discussions, and identify resources (Institute for Healthcare Improvement, 2014).
Quality improvement measures may be developed by a multidisciplinary team in a form of an algorithm. Nurses may assess individual patients and follow the flow chart in order to distinguish ambulation needs based on the individual patients’ physical capabilities. The US Department of Health & Human Services has provided an improved mobility algorithm for patients at risk for deconditioning. The flow chart provides the exclusion and inclusion and exclusion criteria for initiation of consistent measures for initiation of the mobility algorithm.
The Team STEPPS is an evidence based teamwork tool used to improve communication and team skills amongst health care professionals in order to provide high quality, safe patient care. The Team STEEPS approach provides a framework to increase team awareness, effective communication, and clear understanding of team roles and responsibilities. Conflict resolution, improving allocation of information, and eliminating barriers to quality and safety are additional areas the Team STEPPS initiative contributes to the development of quality improvement interventions. Team STEPPS consists of three phases: Phase 1: Assess the need. The needs assessment consists of determining the need for improvement based on the readiness for change, areas of weakness, barriers for change, and available resources. The specific problem is identified using a team approach and existing procedures and policies are analyzed to develop improvement interventions. Goals and outcomes are defined in this process Phase 2: Planning, training, and implementation. During this phase, training methods are decided and the training plan is developed by the multidisciplinary group.
Instructional materials and resources used
The instruction materials and resources to be used will be a variety of literature on the pathophysiology of HSP and potentially modifiable risk factors, framework for, huddle messages, patient educations materials and educational visual aids for the unit boards. Literatures on hospital acquired pneumonia (HAP) prevention articles of interest will be included on: current smoking, patient positioning, postoperative pain control, decontamination of upper aerodigestive tract, acid suppression, endotracheal tube, ventilator management, pulmonary hygiene, sedation, mobility, nasogastric and feeding tubes, hand hygiene, antibiotic stewardship. The handout and textual materials will be used by the staff as an educational tool. The Instructional resources materials and resources being used will be power point presentation with a handout for all participants to follow along with the lecture. Enlarged photographic prints can be incorporated into the wall harts, textual materials, wall charts, connected to form a useful instructional medium. Such sequences are particularly suitable for use in programmes designed for individual study. Providing an enriched supplementary study material will increase the learners motivation through visually-attractive or material.
Identification of evaluation methods.
Case studies of patients with HAP will be reviewed with the learners in groups so they can use each other’s knowledge to gain insight. This method will help nurses to use and improve their critical thinking skills and help each other through the change of the new process. The materials are beneficial to be used by nurses who are unable to attend the lecture. This will allow nurses to take their continuing education into their own time. The trainer will be available by phone or e-mail to answer questions or concerns of the nursing staff. Evaluating the learners’ knowledge throughout and after the learning module for HAP prevention will be completed by reviewing the information covered, tests, discussions, participation in the case studies, and questions throughout and following the presentation. These methods of evaluation will allow the instructor to evaluate the knowledge of the nursing staff. An evaluation of the course and instructor will also be filled out by the nursing staff to allow for proposed improvements, ideas for better instructional methods, and possible ways to add more or less information to the program to improve the teaching and learning outcomes and the nurses’ capacity to learn the most information.
Conclusion
Hospital acquired infections were the number one cause of patients death unexpectedly most of these HAP’s were acquired on medical surgical units other than ICU. There were a lot of initiatives to prevent this occurrence and the elements of the ROUTE Bundle are not new but basic interventions that overlap with the number of initiatives promote early ambulation. The ROUTE bundle is a multi-setting intervention that reduces the incidence of HAP and consistent performance of the bundle will have a substantial impact on their risk of developing it, but also a long term functioning and mobility.

References
Dulaney, P. & Stanley, K.M. (2005) Accomplishing Change in Treatment Strategies. Journal of Addictions Nursing, 16. 165-167.
Seymann, G. B. (2008). Health care-associated pneumonia: meeting the clinical challenges. The journal of respiratory diseases , 208-213.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Textbook of medical-surgical nursing (12th edition) . Lippincott Williams & Wilkins.
Timmins, F. (2008), Communication Skills: Challenges Encountered. Nurse Prescribing, 6(1), 11-14.
U.S. National Library of Medicine National Institutes of Health. (2011). Infectious diseases: Medline plus. Retrieved from http://www.nlm.nih.gov/medlineplus/infectiousdiseases.html
Zigmond, J. (2010). Pushing for change. Modern healthcare, 8-9.