TLT 471 TQ#3: Was our assignment really a tech plan?

I have been struggling with this notion of technology as an educational solution ever since I joined the LST MS program in 2005. As has been noted in most of the research we have read this semester, a “slapped on” technological solution of any kind that is not integrated into the core curriculum, typically does not yield anticipated learning outcomes. So I have approached this project as an educational intervention which happens to include a robust technology component. As such, my part 1 assessment of the target audience’s current state is more focused on offering a compelling argument to convince them that they have a problem, which at present they don’t see.

My “school district” is a typical average hospital. My hypothesis is that a comprehensive nursing peripheral IV catheter (PIVC) procedure training curriculum, which includes deliberate, increasingly difficult practice with task-based simulators, and human factors simulation, will ultimately reduce the number of peripheral IV catheter (PIVC) insertion attempts and the length of the PIVC procedure resulting in less adverse events like pain, phlebitis, infiltration and infection.

The need to build this compelling argument was discovered after researching many new hire nursing orientation programs. New nurse graduates (who have usually received no previous training in the PIVC procedure) receive 15-60 minutes of venipuncture procedural skills training in a classroom setting. During this brief training, they received a didactic lecture that reviews the the hospital's venipuncture procedure (checklist) and the classroom instructor models the procedure with a simulated prosthetic plastic arm. The instructor is often a nurse who is not certified in the venipuncture procedure. The full capabilities of the prosthetic simulation arm are typically not used during the training presentation and quite often the procedural instructions given are not up to date with current Infusion Nursing Society guidelines. Student practice on the prosthetic plastic arm during the classroom training is also usually voluntary. After this orientation, most new hire nurses are matched with hospital unit preceptors who are responsible for validating the new hire nurse’s PIVC procedure competency. Preceptors are usually not certified PIVC procedure practitioners nor has their procedural competency been validated or assessed before taking on the preceptor role. Typically, there are no formal new hire nurse PIVC competency criteria, no number of procedures required, and no summative assessments. Usually, these non-certified preceptors subjectively determine when new hire nurses can do the PIVC procedure competently based upon their own individual requirements.

Even though program instructors often recognize deficiencies in the PIVC training component of new hire nurse orientation resources are always limited and they often feel that their executive administrators will not see any value in freeing up additional PIVC instructional time. Since increased instructional time with a new mastery learning technology-based curriculum is needed to test our hypothesis, my “current state” assignment needs to include a review of these typical existing instructional issues. I needed to make credible predictions of patient risk associated with current instructional practices. Unless potential gaps are clearly identified and agreed to by all key stakeholders in any hospital I have no hope of selling them on the vision of a better mastery learning technology-based curriculum or its subsequent implementation.