Download QSEN-Aquarium-Abstract

Running head: QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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Abstract
This article presents a teaching strategy which incorporates the Quality and Safety Education for
Nurses (QSEN, 2014) competencies. Student learning was facilitated by using an aquarium and
pump to demonstrate advance cardiac function. Evaluation of the teaching strategy was
accomplished via pre- and post-test using audience response system and students’ self-report of
content comprehension. Students were asked to troubleshoot cardiac function problems
demonstrated with an aquarium pump. Following the activity, students reported an
understanding of concepts and terminology. Overall, higher post-test scores were obtained after
this demonstration. Additional teaching strategies to strengthen QSEN (2014) competencies in
nursing education are also described.
Key words: cardiac function; innovative teaching, active learning
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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Senior level students enrolled in an undergraduate Bachelor of Science of Nursing (BSN)
program were overwhelmed with advance concepts of cardiac function, hindering their
comprehension of the content. The nursing program is offered at a private comprehensive liberal
arts college in the Southeastern United States. The program follows the American Association
of Colleges of Nursing (AACN) and the Quality and Safety Education for Nurses (QSEN)
initiative, incorporating quality and safety competencies, such as evidence-based practice (EBP),
into the curriculum framework. The class consisted of seventeen senior level BSN students
enrolled in the 2014 Fall Semester. The educator developed an audiovisual, classroom teaching
strategy for prelicensure nursing students using an aquarium and pump to demonstrate cardiac
function. To link the demonstration to specific cardiac disease states and how they would look
in the clinical setting, the demonstration was referred to as material was presented (preload with
shock, afterload with hypertension, etc.). For example, the pump was submerged to demonstrate
volume overload along with a discussion of clinical symptoms and anticipated treatment for
volume overload.
Discussion Questions
Discussion questions focused on the QSEN (2014) competencies of safety and EBP
related to preload, such as: What conditions could affect blood volume? How would the client
with those conditions look? What assessment findings would the nurse expect? What treatment
would the nurse anticipate? How would the nurse evaluate the treatment? Discussion questions
related to afterload, such as: What conditions could affect vascular resistance? How would the
client with those conditions look? What assessment findings would the nurse expect? What
treatment would the nurse anticipate? How would the nurse evaluate the treatment?
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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QSEN Competency and Objectives
The related QSEN (2014) competency of EBP includes integration of best current
evidence with clinical expertise and client/family preference and values for delivery of optimal
health care. The existing lesson plan included the following QSEN related learning objectives,
which required an understanding of cardiac function:
Objectives: Knowledge
1. Demonstrate knowledge of basic scientific methods and processes
2. Compare the various methods of hemodynamic monitoring (e.g., central venous pressure,
pulmonary artery pressure, and arterial pressure monitoring)
3. Compare and contrast the continuum of normotension, prehypertension, hypertension,
and hypertensive crisis.
4. Describe the action, side effects, and adverse reactions of antihyperlipidemics and
peripheral vasodilators.
5. Describe the nursing care of a client who has undergone cardiac surgery.
6. Summarize the pathophysiology, clinical manifestations, and treatment of myocardial
infarction.
7. Compare and contrast diastolic and systolic heart failure (HF), including pathophysiology
and clinical manifestations.
Objectives: Skills
Theory application included simulated lab experience and clinical practice along with the
following objectives:
8. Describe/Demonstrate the assessment and management of clients with HF.
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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9. Develop a teaching plan for clients with HF. Base individualized care plan on client
values, clinical expertise and evidence
10. Describe/Demonstrate the assessment and management of clients with pulmonary edema.
11. Describe/Demonstrate the management of clients with cardiogenic shock.
12. Locate evidence reports related to clinical practice topics and guidelines
13. Question rationale for routine approaches to care that result in less-than-desired outcomes
Objectives: Attitude
14. Value the concept of evidence-based practice as integral to determining best clinical
practice
15. Value the need for continuous improvement in clinical practice based on new knowledge
Strategy Overview
Students were asked to troubleshoot cardiac function problems demonstrated with an
aquarium and pump. The following principles were demonstrated: First, the aquarium pump is
electrical. Therefore, the pump must be plugged in to receive an electrical charge. Positive
cations (such as magnesium, potassium, calcium, and sodium) provide the electrical charge to the
heart, which is represented by the plugging the pump into the electrical outlet. To help students
retain normal laboratory values, students were taught the 2X4 Rule: representing ideal serum
magnesium and potassium levels for cardiac electrical function being a serum magnesium 2
mg/dL and serum potassium 4 mEq/L. The extension cord was labeled with “K” and “MG” for
demonstration.
Second, the pump requires sufficient volume (preload) to produce cardiac output. This is
demonstrated by adding water from a container marked preload. The pump cannot function
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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effectively or efficiently with a volume deficit or fluid overload. This is demonstrated by either
submerging the pump or lifting the pump out of the water.
Third, the pump must be able to accommodate resistance (afterload) that is demonstrated
by using an obstacle to obstruct outflow. Follow-up discussion addressed the effects of
vasodilator and vasoconstrictor medications.
Finally, the (plastic) fish do not die from lack of water, but lack of oxygen (due to low
perfusion). Follow-up discussion addressed cardiac perfusion, including differences in
ventilation and perfusion, which were identified as difficult concepts for the students.
Evaluation
Evaluation of the teaching strategy was accomplished via pre- and post-test of the class
using audience response system and the students’ self-report of content comprehension. A. The
pre-and post-test items were taken from pre-lecture item bank provided by the publisher of the
required course text book. As such, pre-and post-test items were proprietary property of the
publisher. Additionally, the audience response system questions have since been replaced with
adaptive learning technology to assess class preparation, exam preparation, and remediation after
exams. Suggested pre/post questions for future use include:
1. _______, such as potassium, magnesium, calcium, and sodium provide the electrical
charge to the heart. (cations)
2. For optimal electrical cardiac function, the desired serum magnesium is __mg/dL and the
desired serum potassium is __mEq/L (2,4)
3. Preload refers to ______. (volume)
4. Afterload refers to __________. (resistance)
5. Cardiac function is required for tissue _________. (perfusion)
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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Because this demonstration was not designed as a research project, Internal Review
Board approval was not obtained and no additional data collected. Overall, students had higher
post-test scores after this demonstration, with students consistently answering preload and after
load questions correctly throughout the semester after the demonstration.
Students’ Self-Report of Content Comprehension
Students in subsequent cohorts were divided into “think, pair, share” groups, creating
posters on the discussion questions to present to the class. Student feedback was overwhelming
positive. One student said, “The use of the aquarium brought the ‘mystery of cardiac function’
to actually understanding the how's and why's of heart issues. I pictured the ‘stuck turtle’ during
the test and it helped me choose the right answer”. After using an aquarium and pump to
demonstrate advance cardiac function, students reported an understanding of concepts and
terminology. Overall, higher post-test scores were obtained after this demonstration. A former
student reported drawing on the concepts while providing client education related to
preload/afterload.
To promote self-assessment and incorporate test-taking strategies, the educator ends each
unit by asking the students to identify the most important concept they learned in class. Together
the students and educator write a National Council Licensure Examination (NCLEX) style
question with plausible distractors. Students in the original cohort wrote the following exam
question:
To increase cardiac output, the nurse knows the goal of therapy is to: (Select ALL that apply)
A.
B.
C.
D.
Increase preload
Decrease preload
Increase afterload
Decrease afterload
The question has been subsequently modified as follows:
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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Which of the following would increase cardiac output? (Select ALL that apply)
A.
B.
C.
D.
E.
Administration of IV fluids as ordered
Administration of a diuretic as ordered
Administration of a vasoconstrictor as ordered
Administration of a vasodilator as ordered
Administration of oxygen to keep oxygen saturation greater than 94% as ordered
Both questions demonstrated reliable item analysis on course examinations. These
activities satisfy the National League for Nursing’s (NLN, 2007) Nurse Educator Competency of
Facilitate Learning and the following NLN (2009) Ten Principles of Learning:
Students made and maintained connections mentally and experientially; learning was an active
search for meaning by the student, constructing knowledge rather than passively receiving it;
learning can be informal and incidental.
Strategy Materials
No funding was received for this activity and no animals were used with this
demonstration. The demonstration required no special adaptation of the aquarium or pump,
other than a means to obstruct the pump. The equipment used included an electrical cord and
pump to represent the electrical aspect of the heart, a basic aquarium, a bottle of water labeled
preload, and a plastic turtle labeled afterload to obstruct the pump. For demonstration, the
extension cord was also labeled with “K” and “MG”. This demonstration has since been
presented at two NCLEX review programs, a professional educator conference, and in a peerreviewed journal, receiving overwhelmingly positive feedback as well.
Strengthening QSEN Competencies in Nursing Education
This activity specifically strengthened the QSEN (2014) competency of safety and EBP
by developing the students’ knowledge of the pathophysiology, clinical manifestations, and
treatment related to altered hemodynamic function, the effect of hyperlipidemia and peripheral
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
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resistance, vasodilators. Classroom activities included comparing and contrasting assessment
and management of clients with various types of shock. The strategy strengthened the QSEN
(2014) competency of EBP as faculty shared clinical practice topics and guidelines. The
simulated lab experience and clinical practice strengthened the QSEN (2014) competency of
interdisciplinary teamwork & collaboration as students applied core measures to assess and
manage clients with HF. The strategy strengthened the QSEN (2014) competency of quality
improvement as simulation provided a safe environment to question care that resulted in lessthan-desired outcomes. Furthermore, the strategy strengthened the QSEN (2014) competency of
patient-centered care and informatics as students used technology to complete an individualized
concept map based on client values.
In conclusion, this activity allowed students to grasp the difficult concepts of cardiac
function and apply them in a classroom activity. Students’ performances on course examinations
throughout the semester demonstrated their retention of the material. The results demonstrate
this is an effective active learning strategy to introduce students to advance cardiac concepts.
Additional studies may help provide evidence base strategies for active learning and methods to
evaluate active learning.
QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO
DEMONSTRATE CARDIAC FUNCTION
References
National League for Nursing. (2009). Building a science of nursing education: Foundation
for evidence-based teaching- learning. New York: National League for Nursing
National League for Nursing. (2007). Nurse Educator competencies: Creating an evidencebased practice for nurse educator s. New York: National League for
Nursing
Quality and Safety Education for Nurses. (2014). QSEN Competencies.
Retrieved from http://www.qsen.org/competencies/
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