msn capstone presentationmsn capstone project: neonatal abstinence syndrome (nas): increasing the...

MSN Capstone Presentation

Kate Colvin, RNC-OB, LCCEUniversity of Saint Mary

Personal/ Professional Nursing PhilosophyMy metaparadigm of nursing:

● Person = labor patients, families, and their babies

● Environment = the delivery room, our hospital, and our community

● Health = the labor process, complications, and illness

● Nursing = the knowledge base specific to obstetric nursing

ANA Code of Ethics Provision 1: “Affirming Health through Relationships of Dignity and Respect” ● Bond → Trust

● Labor P.A.I.N. → Purposeful, Anticipated, Intermittent, and Normal

● Explanations → Expectations

.

Personal/ Professional Teaching Philosophy

Effective teachers:

● Help students make a personal connection to the material

● “Why do I need to learn this?”

● Present information in a variety of ways

● Use real world examples

● Encourage participation

MSN Capstone Project:

Neonatal Abstinence Syndrome (NAS):

Increasing the Knowledge Base of BSN Nursing Students

Problem:

● Neonatal abstinence syndrome (NAS) could be addressed on the NCLEX

● Nursing students do not have an in-depth discussion on NAS

● Potential knowledge deficit regarding NAS

● Could hinder ability to successfully answer NCLEX questions about NAS




Purpose:

● Prepare and deliver a lecture for the nursing students at Shepherd University

● Increase their knowledge base regarding neonatal abstinence syndrome (NAS)




Current Evidence:

● NAS is the medical term for newborns experiencing withdrawal as a “result of the

sudden discontinuation of fetal exposure to substances that were used or abused by

the mother during pregnancy”

● Infants with NAS require specialized evidence-based neonatal/pediatric nursing care

● West Virginia had the highest number of opioid overdose deaths in 2016 (733 deaths)

● Highest number of NAS infants in 2013 with 37 cases per 1000 live births




Project Framework: Watson’s theory of caring

● Caring is an essential trait in nursing; course curriculum and learning experiences

should be grounded in real life experiences exhibiting caring science

● A lesson on NAS based on caring theory will focus on discussion and observation

of an actual NAS newborn assessment




Lesson Objectives: At the conclusion of this lesson, students will be able to:

1. Define neonatal abstinence syndrome (NAS)

2. Identify signs/symptoms of NAS

3. Appropriately assign an NAS score using the Finnegan scoring system

4. Describe treatment options for newborns diagnosed with NAS

5. Identify comfort measures to soothe newborns with NAS

6. Discuss coping strategies for parents of newborns with NAS

7. Develop a care plan for a newborn with NAS




Methods:

● Lecture on symptoms of NAS, treatment options, and appropriate plan of care

○ Included history of opiate abuse and current stats for WV to demonstrate

relevance of this topic to students’ own nursing practice

● Video demonstration of an NAS assessment gave the students the opportunity to:

○ Visually identify the signs of NAS

○ Use the Finnegan system to assign a score

○ Determine appropriate interventions




Methods (cont’d):

● Online multiple-choice pre-test to assess student knowledge of NAS

● Same exam as a post-test after the lesson

● Self-assessment of NAS knowledge prior to and after the lesson

● Data collected was analyzed to determine the extent of student learning




Results:

● Analysis of the pre-test and post-test survey

data showed evidence that the knowledge

base of the students was increased

● Average score for the pre-test was 88%

● Average score for the post-test was 96%

● Every question showed improvement in score




Results (cont’d):

● 36 students indicated that their

knowledge of the topic was 3 or 4

prior to the lesson

● 43 students rated their knowledge

as 4 or 5 at the conclusion of the

lecture




Results (cont’d): Qualitative student feedback

● “Really enjoyed this presentation. Feel like I learned a lot. Thank you!”

● “Loved it!”

● “Wonderful presentation, very useful.”

● “Professor Colvin had a great presentation. She provided plenty of background

information and used real life examples. It was very interesting and I learned

more about NAS.”

● “The video was a good addition to help visualize. Also, the information on all the

drugs at the beginning was very interesting and eye opening. Helpful background

information.”




Implications:

● There was an increase in the knowledge of these students concerning NAS as a

result of this lesson

● Infants with NAS require specialized nursing care and this lesson provided this

group of students with the knowledge necessary to provide such care, including

recognition of NAS symptoms, treatments, and comfort measures

● This lesson could be used to educate future classes about NAS




Conclusions:

● Potential knowledge deficit regarding NAS could hinder ability to successfully

answer NCLEX questions

● The purpose of the project was to prepare and deliver a lecture for the nursing

students to increase their knowledge base regarding NAS

● Lesson included symptoms of NAS, treatment options, and appropriate plan of

care, as well as, the history of opiate abuse and current stats for WV




Conclusions (cont’d):

● Video demonstration of an NAS assessment gave the opportunity to visually

identify the signs of NAS, use the Finnegan system to assign a score, and

determine appropriate interventions

● Online multiple-choice pre-test and post-test surveys were used to assess student

knowledge of NAS, along with student self-assessments of NAS knowledge prior to

and after the lesson

● Quantitative analysis of the survey data and self-assessments showed evidence

that the knowledge base of the students was increased as a result of this lesson

Evidence of Achievement of

MSN Program Outcomes

Graduates of the MSN Program will:

1. integrate comprehensive assessment, theory, evidence, clinical

judgment, research, patient values, and interprofessional perspectives in

advance nursing practice for diverse populations and environments.

● NU607: Advanced Health Assessment

○ Integrated comprehensive assessment skills with clinical judgement

● NU745, NU747, NU749: The Capstone project

○ Required extensive research into the theory and evidence

○ Advanced interprofessional practice learning to teach diverse populations

● NU701: Foundations of Advanced Nursing Practice

○ Integrated nursing theory and research into advanced practice goals

2. utilize information and technology to communicate, educate, manage

knowledge, mitigate error, and support decision making for quality

improvement processes.

Every course in the MSN program required:

● Utilization of information and technology to manage acquired knowledge

● Communication with instructors and peers through weekly discussions, formal

papers and the creation of a professional portfolio.

● Sources to be verified to educate and mitigate errors in the presentation of

information.

3. synthesize ethical, economic, legal, and political factors that influence

health care to influence the organization and financing of health care and

educational delivery systems.

NU 705: Healthcare Policy and Ethics

● Social, historical, economic, and political influences on American health care policy

● Impact of policy/regulations on accessibility, accountability, and affordability

● Financing, legal and quality issues of health care delivery

● Global impact of healthcare policy

NU 703: Analysis and Utilization of Research

● Ethical issues in design, conduct, and utilization of research

● Relationship between research, healthcare policy, and quality improvement

4. collaborate to design, coordinate, and evaluate patient-centered health

care as a leader or member of an interprofessional team.

NU727: Curriculum Design and Evaluation

● Design, coordinate, and evaluate a labor support skill workshop

○ Theoretical, patient-centered, evidence-based continuing education course

○ OB nurses to learn (or refresh) labor support skills

○ Non-pharmacological interventions for the pain of labor and childbirth

5. contribute to nursing practice to improve health care outcomes by

translating evidence into practice.


● Improve healthcare outcomes for women undergoing the childbirth experience

● Improve the nursing practice of the OB nurses caring for these patients.

NU745, NU747, NU749: The Capstone project

● Improve the healthcare outcomes of neonates (and their families) affected by

NAS by educating these students on the assessment, care, and treatment of

these patients.

6. integrate evidence based findings for patient-centered and culturally

responsive strategies for clinical prevention and health promotion for

diverse populations and environments.

NU745, NU747, NU749: The Capstone project

● Educate nursing students to provide patient-centered, culturally responsive care.

● Health promotion strategies for the clinical prevention (or minimization) of NAS

symptoms for neonates from diverse populations and environments.

NU611: Informatics in Nursing

● Introduce a patient-centered nitrous oxide program on an OB unit

● Developed by integrating evidence-based findings and culturally responsive

strategies for the health promotion of laboring women.

7. advocate for policies to improve population health, access to quality

care, and the profession of nursing.

NU 705: Healthcare Policy and Ethics

● Healthcare policies were examined, including the role of nurse researchers

● Ethical principles were used to advocate for policies to improve population

health and the profession of nursing.

● Discussions about access to quality care and how healthcare policies are related

to quality, costs, and patient satisfaction.

8. provide evidence of professional and personal goal development and

activities.

Teaching Portfolio:

● Examples of professional development and activities

● Examples of personal goal development

9. integrate the 5 C's of caring - commitment, conscience, competence,

compassion, and confidence - in advanced nursing practice.

● Commitment to professional integrity, excellence, and patient-centered/

evidence-based healthcare

● Conscience caring demonstrated in the labor support skills project, as well as, the

nitrous oxide project.

● Competence is demonstrated through the successful completion of every course

● Compassion is an innate nursing quality that must come from within

● Confidence comes from experience, a trait that has been cultivated throughout

this program

National League of Nurses (NLN) Core Competency Evaluation

NLN Competency 1 - Facilitate Learning

Prenatal Class Instructor

● Redesigned the course to incorporate a variety of teaching techniques

● PowerPoint presentations include video clips, illustrations, and diagrams

● Written materials for each student include handouts to augment books provided

● Games to facilitate learning, such as “Safe or Not Safe” in pregnancy.

Certifications in Inpatient Obstetrics, EFM, and as a Lamaze Childbirth Educator

● Indicates my commitment to professional growth

● Increasing my individual knowledge base

● Modeling a higher standard of nursing practice for my colleagues and students

NLN Competency 2 -

Facilitate Learner Development and Socialization

Clinical Nurse Educator for BSN nursing students

● Observe the interactions between nurses, patients/families, and providers

● Develop a sense of what professional nursing looks like in “the real world”

● Discuss their future professional goals and ways to achieve them

● Realize their potential to become excellent practitioners, no matter what

specialty they choose

NLN Competency 3- Use Assessment and Evaluation Strategies

AWHONN Intermediate Fetal Monitoring Course Instructor

● Course designed to standardize terminology for describing fetal heart rate patterns

○ Facilitate effective communication and promote patient safety

● Goal is to understand the physiology behind fetal heart rate patterns, assessment

strategies, and the interventions to alleviate decelerations

● Assess and evaluate learning using hands-on return demonstrations for skills

○ Leopold’s Maneuvers, insertion of internal monitors, and auscultation of FHR

● Relate the material to real-life situations and encourage participation

NLN Competency 4- Participate in Curriculum Design and

Evaluation of Program Outcomes


● Developed a curriculum for a unit-based series of continuing education

opportunities for L&D staff to learn about pain management techniques

● This evidence-based research project included:

○ identifying program outcomes

○ developing competency statements

○ writing learning objectives

○ selecting appropriate learning activities and evaluation strategies

NLN Competency 5- Function as a Change Agent and Leader

Lamaze Certified Childbirth Educator

● Revised course material to better reflect the Lamaze philosophy of labor and birth

● Incorporated new videos and handouts that explain the Six Healthy Birth Practices

● Addressing the educational needs of our local patient population

My research interests:

● Non-pharmacological methods of labor pain relief and how this relates to maternal

satisfaction with the birth experience

● Nitrous oxide program for those who cannot get or do not want an epidural or IV

pain medication in labor

NLN Competency 6- Pursue Continuous Quality

Improvement in the Nurse Educator Role

● Successful completion of this MSN program

● Certifications in Inpatient Obstetrics, Electronic Fetal Monitoring, and Lamaze

Childbirth Education

● Commitment to professional growth and excellence

NLN Competency 7- Engage in Scholarship

Gestational diabetes mellitus (GDM) class

● Collaborated with the diabetic educator; developed a PowerPoint presentation,

handouts, and patient education materials

Labor support skills workshop

● Design course for OB staff nurses to develop and sharpen their skills providing

nonpharmacologic methods of pain relief.

○ Methods include massage, positioning, breathing, hydrotherapy, and

continuous labor support

○ Enhance interpersonal skills and confidence

NLN Competency 8-

Function within the Educational Environment

Clinical Nurse Educator for BSN nursing students

● Staff nurse on the labor and delivery (L&D) unit

● Familiarity with the hospital and unit policies and procedures

● Connections to develop a collaboration between unit and nursing school

Certifications in Inpatient Obstetrics, EFM, and as a Lamaze Childbirth Educator

● Indicates my commitment to education

● Models a higher standard of nursing practice for my colleagues and students

Future Goals

Prenatal Class Instructor

Clinical Nurse Educator

DNP or PhD?

Certified Doula?

Questions?

ReferencesCandela, L. (2012). From teaching to learning: Theoretical foundations. In D. M. Billings & J. A. Halstead (Eds.), Teaching in nursing: A guide for faculty. (p. 202-243). St. Louis MO: Elsevier Saunders.

Clark, L., & Rohan, A. (2015). Identifying and assessing the substance-exposed infant. MCN. The American Journal of Maternal Child Nursing, 40(2), 87–95; https://doi.org/10.1097/NMC.0000000000000117

David. (2017, May 12). Considerations for data collection in pre-test/post-test designs. Statistics Solutions. Retrieved from http://www.statisticssolutions.com/considerations- for-data-collection-in-pre

-testpost-test -designs/

Gomez-Pomar, E., & Finnegan, L. P. (2018). The epidemic of neonatal abstinence syndrome, historical references of its’ origins, assessment, and management. Frontiers in Pediatrics, 6, 33.

https://doi.org/10.3389/fped.2018.00033

Grossman, M. R., Berkwitt, A. K., Osborn, R. R., Xu, Y., Esserman, D. A., Shapiro, E. D., & Bizzarro, M. J. (2017). An initiative to improve the quality of care of infants with neonatal abstinence syndrome.

Pediatrics, 139(6). https://doi.org/10.1542/peds.2016-3360

Johnson, B. (2017). Neonatal abstinence syndrome. Pediatric Nursing, 43(4), 206. Retrieved from https://www.pediatricnursing.net/issues/17julaug/206.pdf

Jones, H. E., & Fielder, A. (2015). Neonatal abstinence syndrome: Historical perspective, current focus, future directions. Preventive Medicine, 80, 12–17. https://doi.org/10.1016/ j.ypmed.2015.07.017

Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), e547–e561. https://doi.org/10.1542/peds.2013-3524

MacMullen, N. J., Dulski, L. A., & Blobaum, P. (2014). Evidence-based interventions for neonatal abstinence syndrome. Pediatric Nursing, 40(4), 165–172, 203. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/25269356

National Council for State Boards of Nursing. (2016, April). NCLEX-RN detailed test plan. Retrieved from https://www.ncsbn.org/2016_RN_Test_Plan_Candidate.pdf

National Institute on Drug Abuse. (2018, February 28). West Virginia Opioid Summary. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/west-virginia- opioid-summary

National League of Nurses (NLN) Competencies for Nurse Educators. Retrieved from http://www.nln.org/professional-development-programs/competencies-for-nursingeducation

Signs, S. (n.d.). Modified Finnegan Neonatal Abstinence Score Sheet. Retrieved from https://www.lkpz.nl/docs/lkpz_pdf_1310485469.pdf

http://paperpile.com/b/eRccpc/kQxH

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