Essay NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

Week 1: Education Practicum Project Ideas (graded)

Read the guidelines and grading rubrics for the introductory problem statement, literature review and intervention/evaluation plan and discuss your ideas for a Education Practicum Project with your mentor. The Education Practicum Project is a major component of the practicum experience. It should be an activity that will benefit the organization and contribute to your ability to achieve the course outcomes. Remember that your Education Practicum Project should focus on a nursing education issue rather than a clinical issue. A list of suggested Education Practicum Project topics for educator students is available below to help you develop your paper along with the guidelines and rubric for this discussion. This is an opportunity to brainstorm with your classmates and instructor.

Discussion Question

NR 621 Education Practicum Project Ideas

Describe the nursing education issue. What evidence-based practice educational intervention (teaching methodology) do you propose? How will this educational intervention help the nursing education issue? Provide your PICOT question using the standard PICOT format. You may use the attached PICOT worksheet as a guide; however, if you use this document, please copy and paste the document into the discussion.

For example, let’ say that you are in a pharmacology didactic course for your practicum site and your mentor states that students are exhibiting very low test scores. The class is currently being taught by the use of PowerPoint and lecture. You and your mentor decide to implement a flipped classroom to see if the students understand the concepts better and improve test scores. Your PICOT question could look like this:

In first year nursing students enrolled in the pharmacology course, will a flipped classroom as compared to PowerPoint and lecture improve test scores in eight (8) weeks?

NR621 W1 Education Practicum Project Ideas & PICOT Guidelines & Grading Rubric (Links to an external site.)

NR621/622 PICOT Question Worksheet (Links to an external site.)

NR621 Potential Education Practicum Project Topics download

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Collapse SubdiscussionShannon Miller

Shannon Miller

Jul 5, 2021Local: Jul 5 at 10:17am Course: Jul 5 at 11:17am

Dr. Bonney and class,

Over the last 8 years of my career as an inpatient rehabilitation nurse, I have found that there is a lack of recognition of rehabilitation nursing as a specialty. Limited awareness and education could be some source of this misinformation, but often we are categorized under the same nursing skill as the skilled nursing facilities which cannot be more incorrect. With this misinformation, often nurses entering the inpatient rehabilitation setting are misinformed of their expectations as an inpatient rehabilitation nurse. Rehabilitation nursing identifies the uniqueness of the patient, offering support to their changing lifestyles which emphasizes the caring model of Jean Watson which does not consider health as absence of a disease. Watson identifies health as the ability to manage and find meaning with life’s current circumstances (Roulin et al., 2020).

Often there is no separation between general RN orientation and rehabilitation nursing as a specialty when hired within a network. By introducing an inpatient rehabilitation nurse internship during the new hired nurse’s hospital orientation would help expedite the develop of knowledgeable competent inpatient rehabilitation nurses.

Developing an inpatient rehabilitation nurse internship with a blended learning method with potential for a flipped classroom environment would be beneficial to the educator and the learner. Blended learning has been identified as a quality alternative learning strategy that integrates practice with nursing theory (Wu et al., 2020). Allowing nurses to view online modules and learn at their own pace prior to entering the classroom setting will allow the nurse to develop questions on content that can be clarified in the classroom setting and give the educator first-hand knowledge of specific concepts and skills that may need more attention.

P- Nurses hired into the inpatient rehabilitation setting.

I- Identify the need for an inpatient rehabilitation nurse internship for nurses hired into the inpatient rehabilitation setting through blended learning methods.

C- Compared to no inpatient rehabilitation nursing specialty education during nursing orientation.

O- Validate the need to introduce rehabilitation nursing knowledge during nursing orientation to initiate the inpatient rehabilitation nursing model evaluated through surveys of current inpatient rehabilitation staff.

T- During first 6 weeks of orientation.

PICOT Question:

In inpatient rehabilitation nurses newly hired to the network, would an additional inpatient rehabilitation nurse specialty internship compared to no additional specialty nursing orientation improve the nurses understanding of their role and expectations as an inpatient rehabilitation nurse during their 6 week orientation.

Roulin, M., Jonniaux, S., Guisado, H., & Sechaud, L. (2020) Perceptions of inpatients and nurses towards the importance of nurses’ caring behaviours in rehabilitation: A comparative study. International Journal of Nursing Practice, 26(4), 1-9. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1111/ijn.12835 (Links to an external site.)

Wu, X., Chi, Y., Selvam, U., Devi, M., Wang, W., Chan, Y., Wee, F., Zhao, S., Sehgal, V., & Ang, N. (2020). A clinical teaching blended learning program to enhance registered nurse preceptors’ teaching competencies: Pretest and posttest study. Journal of Medical Internet Research, 22(4), 1-13. https://doi.org/10.2196/18604 (Links to an external site.)

Collapse SubdiscussionLeigh Bonney

Leigh Bonney

Jul 5, 2021Local: Jul 5 at 10:38am Course: Jul 5 at 11:38am

Hi Shannon,

NR 621 Education Practicum Project Ideas

Thank you for starting our first discussion of your practicum experience! Your idea sounds lovely for a project, but it may be beyond th scope of this course. You also want to focus on a teaching intervention. Preparing and developing a new orientation process is better suited to a DNP project.

Great ideas!

Dr. Bonney

Shannon Miller

Jul 9, 2021Local: Jul 9 at 3:07pm Course: Jul 9 at 4:07pm

Dr. Bonney,

Thank you for the feedback you provided here in our discussion and per our phone conversation yesterday. I have reevaluated my PICOT question to direct my attention to the flipped classroom environment in order to provide the additional rehabilitation nurse education needed to improve nursing knowledge.

Revised PICOT:

P- Nurses hired into the inpatient rehabilitation setting.

I- Identify the need for to educate inpatient rehabilitation nurses hired into the inpatient rehabilitation setting through flipped learning methods.

C- Compared to no inpatient rehabilitation nursing specialty education during nursing orientation.

O- Validate the most appropriate educational method to teach rehabilitation nursing knowledge during nursing orientation to better initiate the inpatient rehabilitation nursing model.

T- During first 6 weeks of orientation.

PICOT Question:

In inpatient rehabilitation nurses newly hired to the network, would additional inpatient rehabilitation nursing education through a flipped classroom environment compared to no additional specialty nursing orientation improve the nurses understanding of their role and expectations as an inpatient rehabilitation nurse during their 6 week orientation?

Shannon Miller

Collapse SubdiscussionLauren Bordenkircher

Lauren Bordenkircher

Jul 8, 2021Local: Jul 8 at 7:31am Course: Jul 8 at 8:31am

Shannon-

What an excellent idea for a practicum project! Every specialty within. nursing I feel is deserving of recognition and specialized training, because there is no way I could leave my ICU world and come be an effective rehabilitation nurse. Always a fan of Watson’s caring theory; and you found a theory that suits your need, nurses care for patients on a continuum of health. As Dr. Bonney mentioned, creating a whole class seems beyond the scope of this course- so I had an idea for you, that may better fit your needs for this project.

What if you created a quick reference guide to rehabilitation nursing for your current population of nurses? Like a pocket card or badge buddy? Or, you could choose one component of waht you would include in your rehab orientation and test it on your audience of current nurses? You could do like a pre and post test after your intervention, and collect subjective feedback from participants as a starting point to further research?

Shannon Miller

Jul 10, 2021Local: Jul 10 at 2:37pm Course: Jul 10 at 3:37pm

Lauren,

I really like the idea of a pocket card or badge buddy! I have decided to focus on the flipped class room for my project, but the pocket card might be something I keep in mind for the overall project at work. In the end I hope to have a rehab internship in place by the end of the year and this is a great idea as a take away after the classroom portion of the class.

Thanks for the feedback!

Shannon

Janice Chua

Jul 11, 2021Local: Jul 11 at 1:59pm Course: Jul 11 at 2:59pm

Hi Shannon,

NR 621 Education Practicum Project Ideas

I enjoyed reading your post; it was insightful and informative too. I agree with you that an inpatient rehabilitation nurse, like any other new nurse enter into a work setting for the very first time, may seems misinformed about what they are supposed to do, for instance, how to handle a patient. This is something I have also noticed in my workplace, and from the experience I have had over the years, this usually result when one is transitioning nursing school to work which has been one of the major challenges nurses tend to deal with. Like you, I also think introducing a rehabilitation nurses internship program would come in handy for the new hired nurses as they would help them be more conversant with a rehabilitation nurse working setting and this help them be settle in quickly as they will be aware of what is expected of them (Wu et al., 2020).

Reference:

Collapse SubdiscussionBrian Reyes

Brian Reyes

Jul 5, 2021Local: Jul 5 at 11:33pm Course: Jul 6 at 12:33am

Hey class,

I’m still working on solidifying an issue and intervention, but my nursing education issue is concerning new nurses or nurses new to specialties who are not demonstrating critical thinking in critical clinical practice. I propose an intervention that utilizes high fidelity simulations to help nurses prepare for actual practice. Newer nurses do not have much experience in critical situations due to the just entering these specialties areas or due to the critical situations being uncommon, so by using simulations, the newer nurses can have more experience in critical situations in a safe environment. This is my PICOT question:

With emergency department nurses in their first year of practicing in this specialty, will high fidelity simulations as compared to PowerPoint and lecture make them feel more comfortable with critical situations in two (2) weeks?

-Brian

Leigh Bonney

Jul 6, 2021Local: Jul 6 at 12:27pm Course: Jul 6 at 1:27pm

Hi Brian, you have developed an excellent Pico question. Your intervention is evidence-based, and this is a feasible project for the scope of this class.

Dr. Bonney

Collapse SubdiscussionLauren Bordenkircher

Lauren Bordenkircher

Jul 8, 2021Local: Jul 8 at 7:36am Course: Jul 8 at 8:36am

Brian-

I, too, am interested in ensuring new nurses are equipped with the skills they need to work safely. How do you propose you will measure your outcome? I like the idea of the nurses feeling more comfortable, but how will you measure this? Maybe you can find a reliable/valid assessment tool to measure perceptions of comfort in decision making or something. For your project, is there a group of new nurses you will be working with? And finally, have you thought about what critical situations you want to include? I am thinking maybe you pick one concept, as many different types of critical situations can walk through the doors of the ED? You’re off to a good start!

Collapse SubdiscussionBrian Reyes

Brian Reyes

Jul 10, 2021Local: Jul 10 at 10:23am Course: Jul 10 at 11:23am

Hey Lauren,

Thank you for your questions; they helped me reflected on what I need to work on. My mentor is an emergency department educator and currently we are working with a group of transitions nurses or nurses who have like a year of experience on med-surg or tele, but have never worked in emergency before. At first, I was thinking of just creating surveys pre and post simulation with regards on how comfortable they feel and also surveys on how much they felt each intervention helped them prepare. Interestingly enough, during my first practicum day, the education staff had discussed that there is not really a quality way to measure improvement in critical situations; I would like to research and figure out a tool or a way to actually measure that, but I’m still in the early stages of planning what to do for my project.

-Brian

Alexis Naish

NR 621 Education Practicum Project Ideas

Jul 11, 2021Local: Jul 11 at 9:13pm Course: Jul 11 at 10:13pm

Hello Brian,

You bring up a very important issue in nursing that is not just in the emergency room. From precepting new nurses the last few years, I have also learned that they need education or training on how to think critically in critical situations. I have precepted experienced tele nurses to the open heart patients, I have also trained new grad nurses to tele, and experienced nurses from other specialties to tele. I don’t know what it is, but even if they have had experience in critical situations, they still need to be oriented and trained to the new environment and expectations. Just like we assess ourselves on the NLN competencies, maybe it would be good for the training nurses to assess their competency on certain things such as how to act in a situation with a hypoglycemic event, acute stroke, acute bleeding, sepsis, things like that.

Collapse SubdiscussionLauren Bordenkircher

Lauren Bordenkircher

Jul 6, 2021Local: Jul 6 at 7:59am Course: Jul 6 at 8:59am

Dr. Bonney and class-

For our first week’s post, we are to describe the nursing education issue we identified that will help to guide our practicum intervention. Since I desire to work as a unit educator for nurses in the hospital setting, this is where I am completing my practicum hours. My mentor is the unit educator for the Neuroscience Unit at Rush Copley in Aurora, IL. There is a group of new graduate nurses (NGNs) starting on the unit in August, and I will be helping my mentor as she teaches them the skills they need not only as new graduates working in the inpatient setting, but also teaching them the skills they need to work on a specialized neuroscience unit. I am excited that my practicum project will have something to do with my interests in supporting NGNs! What great timing of the new grads and my practicum beginning, right?

The educational issue that I am interested in are the challenges associated with beginning practice as an NGN. These specifically include the gap in learning between theory and practice, and transition shock from student to clinician (Aydogan & Ulupinar, 2020). In fact, according to multiple studies, up to twenty three percent of new nurses do not demonstrate entry-level competency and clinical judgement making (Kavanagh & Szweda, 2017, as cited by Zehler & Musallam, 2021, p. 159). New graduate nurses have very specific needs when compared to other nurses who have more experience (Aydogan & Ulupinar, 2020). When NGNs are not given the educational opportunities they require to close the gap from theory to practice, scholars argue it leaves NGNs at risk for reality shock and burnout (Aydogan & Ulupinar, 2020). Burnout not only affects the NGN personally, but can have repercussions for the organization as well.

One way to ensure that NGNs are retaining the knowledge and skills they have learned is through making the learning process more engaging. The nursing education intervention I propose will be introducing gaming into the educational classes these NGNs will be taking. Gaming in learning is an evidence-based practice educational intervention that can help learners to enjoy and interact with the learning process (Zehler & Musallam, 2021). I do not know what portion of their learning I will be carrying out (I start my first day of practicum tomorrow and my mentor and I need to sort out the details), I will hopefully have it narrowed down by the end of this week.

Here is my “rough draft” PICOT (I recognize that it will probably change slightly once I discuss the specifics with my mentor): In new graduate nurses beginning their practice in the inpatient setting on a specialized neuroscience unit, will the introduction of gaming into orientation help support knowledge retention and engagement during the course of classroom learning time?

Population: New Graduate Nurses (NGNs) beginning practice in the inpatient setting on an inpatient, specialized neuroscience unit

Intervention: Incorporation of gaming into NGN clinical orientation

Comparison: Compared to NGNs who did NOT have games during their classroom time

Outcome: Better engagement in the learning process and retention of knowledge evaluated by subjective feedback in the form of survey from NGN and mentor at the end of learning game

Time: During the classroom time allotted to topic being taught to NGNs.

References

Aydogan, Y., & Ulupinar, S. (2020). Determining the learning needs of new graduated nurses working in inpatient care institutions. Nurse Education Today, 92, 1-7. doi: https://doi.org/10.1016/j.nedt.2020.104510 (Links to an external site.)

Zehler, A., & Musallam, E. (2021). Game-based learning and nursing students’ clinical judgement in postpartum hemorrhage: A pilot study. Journal of Nursing Education, 60(3), 159-164. doi: 10.3928/0148434-20210222-07

Lauren Bordenkircher

Jul 9, 2021Local: Jul 9 at 9:24am Course: Jul 9 at 10:24am

This is my updated PICOT:

For the NGN completing their required classroom learning through the new graduate residency program, will the implementation of a flipped classroom approach, compared to a traditional lecture power point presentation, help the NGN to feel more comfortable with the material being presented as evaluated by subjective feedback from the learner?

Abigale Caracci

Jul 10, 2021Local: Jul 10 at 1:43pm Course: Jul 10 at 2:43pm

Lauren,

I was surprised to read that we have developed very similar PICOT questions. I am doing my practicum with one of the leaders of nursing education at my hospital’s corporate office. I was a part of the nurse residency program in the past and I am passionate about improving it. My mentor is the head of this, as well as the traditional nurse orientation. I enjoyed reading your post since I am going to gauge the successful use of simulation on the new graduate nurse confidence level. I look forward to reading more about your project. I believe a flipped classroom approach is a great option to focus on. Best of luck!

NR 621 Education Practicum Project Ideas

Thanks,

Abbey

Janice Chua

Jul 11, 2021Local: Jul 11 at 1:58pm Course: Jul 11 at 2:58pm

Hi Lauren,

Challenges associated with beginning practice have been major problems to most nurses. There are challenges that tend to affect nurses’ successful transition to practice. Transitioning from school to workplace has always been a major issue to most nurses, predominantly finding a niche within the nursing community and knowing the difference between nursing in school and the real world. Most nurse fail to acknowledge that although they might be ought of the nursing school; learning as a nurse does not end as they continue learning while working. I believe it becomes easier for nursing to accept that learning does not stop after school, be open minded to accept that every person has his or her own way of doing things. Another resolution to these challenges it understand that it essential to learn various ways people do things, as this helps one know what works best for them (Aydogan & Ulupinar, 2020).

Reference:

Collapse SubdiscussionJanice Chua

Janice Chua

Jul 6, 2021Local: Jul 6 at 10:46pm Course: Jul 6 at 11:46pm

Strategies for handling the disruptive student

The educational issue chosen for this discussion is disruptive students. Disruptive students consist of behaviors that tend to impede the learning of other students and teaching. These are behaviors that are likely to adversely affect the educational experience and they consist of actions or words altered which are likely to hamper the ability of the teachers and others students to concentrate. These behaviors have the ability to affect other students as they easily escalate. While disruptive students have proved to be a challenge in education, there are a few evidence-based practice educational interventions that would help in addressing this issue. One is establishing procedures and ground rules which come in handy in retaining a sense of order and control in class. One may need to repeat this several times to ensure that the students comprehend and the message sinks in. Another approach is to outlaw the behavior. The teacher ought to, however, condemn the words or behaviors and not the student. The other approach is to avoid shouting and physical contact with disruptive students. While it is sometimes difficult for tutors to remain calm, letting the situation escalate into shouting enhance the likelihood of the one experience more disruptions in the future. Lastly is to ensure that one’s actions are within the school policy (Debreli & Ishanova, 2019). These interventions will help avert these disruptive behaviors, and consequently, increase students’ concentration in the classroom. Also, these interventions will make learning easier and swift as disruptive behaviors tend to be time-consuming as the tutors are often cut short to point out these behaviors.

PICO Question: How should one respond when students start to behave in a manner that disrupts learning in nursing education?

Reference

Debreli, E., & Ishanova, I. (2019). Foreign language classroom management: Types of student misbehaviour and strategies adapted by the teachers in handling disruptive behaviour. Cogent Education, 6(1), 1648629. https://www.tandfonline.com/doi/full/10.1080/2331186X.2019.1648629 (Links to an external site.)

Collapse SubdiscussionBrian Reyes

Brian Reyes

Jul 9, 2021Local: Jul 9 at 11:42am Course: Jul 9 at 12:42pm

Hey Janice,

Interesting start. I like that you have an issue to start off from. Students can be disruptive sometimes and affect the learning environment for those around them. I think your PICO question could just use a little more detail and focus. It seems like it is more of a question for figuring out your intervention. What do you think should be done to respond to disrupting students? Your population could be more specific like undergraduate nursing students. I would be surprised if there is that many disruptive nursing students though. I hope this helps you figure out how to improve on your PICO question.

-Brian

Linda Berking

Jul 10, 2021Local: Jul 10 at 3:31am Course: Jul 10 at 4:31am

Janice,

This is a great PICOT question. I come from a family of teachers and this is an area of challenge for many new educators. A disruptive student can impede the education of the entire class. It is sometimes very difficult to handle but must be handled immediately to maintain control. I will be very interested in seeing your interventions.

Linda Berking

Collapse SubdiscussionElana Yuko

Elana Yuko

Jul 7, 2021Local: Jul 7 at 10:23am Course: Jul 7 at 11:23am

PICOT:

In first year nursing students enrolled in the Med. Surg. 1 Nursing course, will teaching consistent guidelines of insulin times of peak, onset, and duration using gaming as compared to the student utilizing different sources such as their textbooks and PowerPoints for the times, improve quiz scores in 8 weeks?

NR621622 PICOT Question Worksheet.docx

Kendall Neumore

Jul 10, 2021Local: Jul 10 at 2:05pm Course: Jul 10 at 3:05pm

Hi Elana,

I am very interested in the results of your research! I think that gaming is an excellent tool for teaching! One piece of feedback I would like to offer is trying to make your PICOT a bit more concise. For example, for your “I” (intervention), I would say: “does utilizing gaming to teach insulin peak, onset and duration” and for your “C” (comparison), try: “compared to didactic education” or “compared to powerpoint lessons.” This makes your PICOT more specific and clear as to what exactly you are comparing. I think you did a great job with the the “T” by stating your evaluation tool and duration of the research you are completing! Overall, looking forward to reading more about your project in the future!

NR 621 Education Practicum Project Ideas

Kendall

Collapse SubdiscussionLinda Berking

Linda Berking

Jul 7, 2021Local: Jul 7 at 12:29pm Course: Jul 7 at 1:29pm

NR621622 PICOT Question Worksheet (1).docx

Collapse SubdiscussionLinda Berking

Linda Berking

Jul 7, 2021Local: Jul 7 at 12:33pm Course: Jul 7 at 1:33pm

What is the practice issue/problem? What is the scope of the issue? What evidence is there for the need for change? Note that this information is the basis for the introduction of your paper, due in Week 2. (~100 words; this corresponds to your description of your proposed Capstone Project in the discussion thread)

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.

The practice issue is improper documentation of psychiatric patients signs and symptoms, behaviors and outcomes of treatment interventions. This problem directly affects patient care and treatment.

With proper documentation all team members which consist of social workers, nursing, medical physicians, psychiatrist and APN, are aware of the effectiveness or ineffectiveness of treatment. The patient then receives better treatment which ensures a safer discharge and perhaps prevents a rapid readmission.

The lack of proper documentation can lead to a patient being discharged unwell and rapidly being readmitted. Side effects of medication’s not treated can lead to patients stopping their meds and rapidly readmitting. The effectiveness of medications and PRN’s are vital information. Behaviors being displayed. To receive proper treatment provider’s must be aware.

As the Utilization Review nurse, I spend time speaking with the insurance companies doing concurrent reviews. When information is not documented I am unable to ask for further days of treatment. The patient may be meeting criteria, but without documentation it does not exist. Many patient have discharged and very quickly came back with the same symptoms they were originally admitted with.

NR 621 Education Practicum Project Ideas

Formulating the PICOT question — Define each element of the question below:

P- Population and problem – What is the educational or clinical issue or problem and who does it affect?

I- Intervention – What evidence-based solution for the problem would you like to apply? For most nurse educator students, this will be an instructional method or strategy

C- Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or an alternative solution.

O- Outcome – Very specifically, how will you know that the instructional strategy or other intervention worked? For educators, this is typically a graded assessment, standardized examinations, or a learner satisfaction survey.

T- Time frame – For the purpose of NR621/622, this will be short-term. You won’t have time to examine NCLEX® scores or retention of new graduates, for example.

Then state your project question here in the form of a PICOT question (i.e., stick to the PICOT question format:

P- Staff nurses in an acute care setting caring for adult psychiatric patients. Proper documentation of patient receiving acute care mental health treatment. Documentation regarding signs of symptoms of diagnosis, behaviors and outcomes of treatment interventions. This problem directly affects patient care and treatment.

I-Educating regarding proper documentation and its importance. Review of the basic nursing process regarding documentation and common errors. Example of psychiatric nursing documentation.

C-An alternative educational method would be case studies.

O-Learner satisfaction survey highlighting the main points regarding documentation. Monitoring for 1 week the staff nurses’ documentation and any follow up needed.

T-8 weeks.

Collapse SubdiscussionLeigh Bonney

Leigh Bonney

Jul 7, 2021Local: Jul 7 at 4:27pm Course: Jul 7 at 5:27pm

Hi Linda,

Thank you for your post. This is good information and extremely important. We have to document accurately, so education is vital. For this project, you have to have an intervention to deliver that education. You could do simulation, role playing, or whatever intervention you can identify.

Have a good week!

Dr. Bonney

Linda Berking

Jul 10, 2021Local: Jul 10 at 3:35am Course: Jul 10 at 4:35am

Dr. Bonney,

I believe the intervention I would like to use may be considered role playing. I would like to use examples of proper and improper documentation presented in power point. Discuss the many errors that occur in documentation and what should be included in documentation for a psychiatric patient.

Linda Berking

Milagros Gonzales

Jul 11, 2021Local: Jul 11 at 7:30pm Course: Jul 11 at 8:30pm

Linda,

I am very excited to see your research unfold. Though it’s a different type of patient, I just finished mentioning to my professional development team’s nurse educators about reinforcing CIWA education. Often times, I have come into my shift with a CIWA patient needing to be transferred to the ICU, intubated, for airway protection due to being over medicated with Ativan. When I look back to see what their CIWA scores were, not a single CIWA score greater than 4 was documented. Per the orders, Ativan can only be given for a CIWA score greater than 15.

this shows lack of assessment or lack of knowledge on CIWA protocol when medicating. Though a different type of my patient, your post reminded me of this, as it is an educational issue that directly effects patient care.

I am excited to see what else you have in store for this!

Good luck!

Mila

Alecia Clapacs

NR 621 Education Practicum Project Ideas

Jul 7, 2021Local: Jul 7 at 2:42pm Course: Jul 7 at 3:42pm

New graduate registered nurses have commonly expressed a knowledge gap between theory and practice and relay a sense of anxiety and difficulty adjusting to the role of a practicing RN. High workloads, increased patient acuities, complex care issues, and lack of confidence are all factors leading to a difficult adjustment period (Jung et al., 2017). Transition programs, such as the nurse residency program at The Cleveland Clinic, are designed to help new nurses smoothly transition into the professional setting. Currently, the residency program consists of ten, four-hour didactic classes that help new nurses understand the nursing policies, practices, and procedures of The Cleveland Clinic. High-fidelity simulation promotes critical-thinking, clinical reasoning, interprofessional relationships, early recognition of patient changes, and teamwork (Rossler & Hardin, 2020). With this information, I am curious as to the effects of high-fidelity simulation on the perceived clinical competence and preparedness of new graduate registered nurses.

P- New graduate registered nurses

I- high-fidelity simulation

C- didactic learning

O- perceived levels of clinical competence

T- during a four-week period

PICOT Question:

In new graduate registered nurses, does high-fidelity simulation compared to didactic learning increase perceived levels of clinical competence over a four-week period.

Search terms: New graduate registered nurse, high-fidelity simulation, nurse transition, clinical preparedness

References

Jung, D., Hee Lee, S., Jung Kang, S., & Kim, J.H. (2017). Development and evaluation of a clinical simulation for new graduate nurses. Nurse Education Today, 49, 84-89. https://doi.org/10/1016/j.nedt.2016.11.010

Rossler, K.L. & Hardin, K. (2020). Teaching newly licensed RNs to build an interprofessional collaborative practice. The Journal of Continuing Education in Nursing, 51(7), 331-337. https://doi.org/10.3928/00220124-20200611-09

Collapse SubdiscussionAlexis Naish

Alexis Naish

Jul 7, 2021Local: Jul 7 at 3:28pm Course: Jul 7 at 4:28pm

NR621/622 PICOT Worksheet – Week 1

Name: Alexis Cavazos

Date: 07/07/2021

Your Instructor’s Name: Dr. Leigh Bonney

Purpose: To identify an issue that can be addressed by a nurse educator and develop a PICOT question to guide an evidence-based change project.

Directions: Use the form below to formulate a PICOT question. This includes filling in the table with information about your educational issue and your PICOT elements.

Step 1: Identify the educational issue or problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What can you do about that issue? What can you change with the support of evidence in the literature?

NR 621 Education Practicum Project Ideas

Step 2: Select the key PICOT terms for searching the evidence. Clearly define your PICOT question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome), T (Time Frame).

Step 3: What search terms could you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? How will you narrow your search if needed?

PICOT Question

An ongoing problem apparent in the cardiovascular service line at Saint Agnes Medical Center is the occurrence of heparin drip errors. Errors with heparin drips include miscalculation, misuse or misunderstanding of the current algorithm, and using the wrong algorithm. Heparin drips fall under two different algorithms which include the cariology algorithm indicated for acute coronary syndrome or ACS, and the DVT/VTE algorithm. Understanding why the heparin drip is indicated can direct the nurse administering the medication to the correct algorithm. Currently, new graduate nurses are required to take a class covering heparin and insulin drips, and newly hired experienced nurses do not have the same opportunity. Experienced nurses that are newly hired are expected to review the heparin drip policy and algorithm with a preceptor if they do not have a heparin drip during their orientation period.

Formulating the PICOT question — Define each element of the question below:

P- Population and problem – What is the educational or clinical issue or problem and who does it affect?

– Heparin drip errors among staff nurses at Saint Agnes Medical Center

I- Intervention – What evidence-based solution for the problem would you like to apply? For most nurse educator students, this will be an instructional method or strategy

– Heparin class required of all staff, with simulation or scenarios overseen by the nurse educator.

C- Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or an alternative solution.

– The nurse educator or practice coordinator is present when a newly hired experienced nurse is initiating or titrating a heparin drip for their first time.

– Reduced errors.

NR 621 Education Practicum Project Ideas

T- Time frame – For the purpose of NR621/622, this will be short-term. You won’t have time to examine NCLEX® scores or retention of new graduates, for example.

– By the end of the second practicum course.

Then state your project question here in the form of a PICOT question (i.e., stick to the PICOT question format:

In nurses at Saint Agnes Medical Center, will requiring a heparin drip class from all nurses upon hire compared to having the nurse educator present when an experienced nurse initiates or titrates a heparin drip reduce errors by the end of the second practicum course?

Search terms you will use/How will you narrow your search?

Clinical education

Nurse advancement

Hospital classroom

Teaching experienced nurses

High risk medications

Onboarding strategies

Onboarding errors

Gaps in orienting new hires

Instructor comments:

Approved/Date:

Alecia Clapacs

Jul 8, 2021Local: Jul 8 at 2:27pm Course: Jul 8 at 3:27pm

Alexis,

I think this is a wonderful idea to investigate and your PICOT question is well written. I have witnessed a few heparin drip errors myself and when working with a high risk medication, such as heparin, I think further education is important. At my hospital, we have a nomogram that automatically populates expected bolus and infusion rates when new APTT results come in to help decrease errors, but even with that we still must remember to place lab orders, communicate status in handoff, and monitor for adverse reactions. There are many steps that go into properly and safely running a heparin drip and I think a standardized class that all nurses on the unit are required to take is one way to ensure everyone has the same education and understanding of the proper way to handle heparin drips.

I am looking forward to see what literature you find on the topic and how the implementation of a required heparin drip class goes at your practicum site!

NR 621 Education Practicum Project Ideas

-Alecia

Leigh Bonney

Jul 8, 2021Local: Jul 8 at 7:36pm Course: Jul 8 at 8:36pm

Hi Alexis,

This sounds good. I am excited for your project. The only revision I have to your plan is that you will only research simulation. This is your teaching strategy that you are basing your evidence-based project on. You will find 10 articles on simulation which will be the evidence that your project is based on.

Good job.

Dr. Bonney

Collapse SubdiscussionDeborah Thomas

Deborah Thomas

Jul 7, 2021Local: Jul 7 at 5:40pm Course: Jul 7 at 6:40pm

Dr. Bonney and classmates,

PICOT Question

The issue that I would like to address in my Educational Practicum Project is the need for more comprehensive hospice education among health care providers. When asked about their understanding of hospice services, many providers admit that they do not understand when a person could benefit from hospice, how a person could qualify for the hospice benefit, and what services and care that a hospice team can provide. When I started a literature review about hospice education, there was not a lot of published information to assist health care providers in attaining knowledge about hospice.

Formulating the PICOT question — Define each element of the question below:

P- Population and problem – What is the educational or clinical issue or problem and who does it affect?

Health care clinicians working in acute and subacute settings

I- Intervention – What evidence-based solution for the problem would you like to apply? For most nurse educator students, this will be an instructional method or strategy

a comprehensive hospice education program

C- Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or an alternative solution.

No formal hospice education

Clinicians will be able to confidently discuss hospice care as an end-of-life care option as evidenced by passing test at the end of the education

T- Time frame – For the purpose of NR621/622, this will be short-term. You won’t have time to examine NCLEX® scores or retention of new graduates, for example.

By October 15, 2021

Then state your project question here in the form of a PICOT question (i.e., stick to the PICOT question format:

In health care clinicians in acute and subacute care settings, will a formal hospice education program increase the ability to confidently discuss hospice as an end-of-life care option compared to clinicians without formal hospice education by October, 2021?

Search terms you will use/How will you narrow your search?

End-of-life, hospice education, hospice education in nursing education, myths regarding hospice, understanding hospice benefits, perceptions of hospice

Instructor comments:

Approved/Date:

NR 621 Education Practicum Project Ideas

Collapse SubdiscussionLauren Bordenkircher

Lauren Bordenkircher

Jul 8, 2021Local: Jul 8 at 7:41am Course: Jul 8 at 8:41am

Deborah-

What a wonderful idea for a course! Are you familiar with ELNEC ? End-of-Life Nursing Education Consortium (ELNEC) is a group that focuses on teaching nurses about end-of-life nursing care. If hospice and palliative care are an interest of yours, you could look into adding this to your own learning! I took this course years ago and it was very beneficial, I really wish that organizations did more to teach us about the dying patient, since it happens in a lot of nursing settings. Your PICOT says health care clinicians- would you offer this course to care techs, physicians, or other services working in the hospital, too? And how will you measure “confidently discussing” ?

Deborah Thomas

Jul 11, 2021Local: Jul 11 at 9:01pm Course: Jul 11 at 10:01pm

Thank you for your reply, Lauren. I was not familiar with the ELNEC before but am very interested in looking into it more. It looks as if it can be an invaluable resource for me and to pass along to colleagues who are struggling with this topic.

Regarding my PICOT – I would like to have the educational intervention available to clinicians besides nurses. I lead a home care team that includes RNs, LPNs, therapists, and therapy assistances – all of whom may have the opportunity to refer a patient to hospice and/or talk about care options. I think that anyone with direct patient care should have an understanding of what hospice is and be able to have enough base knowledge to engage in a simple conversation or answer a few questions comfortably. In time, probably as a dissertation project, I would like to expand this project to be a formal, comprehensive educational program that would include all clinical health care professionals, including physicians, as well as a modified education program that addresses the general public.

It is kind of funny that you asked about how to measure confident discussion. I hesitated a long time before writing that, but could not think of a better way to state my thoughts. But after speaking with Dr. Bonney on the phone, she helped me to refine my PICOT question and project idea. I am looking at creating an education module (rather than a whole program) and use role-play as a way of increasing skills and confidence in the ability to communicate regarding hospice.

Thank goodness for faculty!!

Deb

Kendall Neumore

Jul 7, 2021Local: Jul 7 at 6:09pm Course: Jul 7 at 7:09pm

Hello Class,

Critical thinking is an essential and foundational skill required in nursing and is defined by the ability to exercise professional judgement based on gathered facts and details typically gained through experience (Yu et al., 2021). Newly graduated nurses generally lack the necessary experience to ascertain confidence in their critical thinking skills and abilities, which will be necessary as they bridge into their professional nursing practice. In order to facilitate this confidence and experience, case-based learning is proposed as an intervention to help new nurses engage in critical thinking in a safe and educational environment.

Therefore, my proposed PICOT is as follows:

P- In new graduate nursing staff

I- Dose case-based learning

C- Compared to the traditional didactic approach

O- Improve perceived confidence in critical thinking abilities

T- Over a 4-week period

PICOT: In new graduate nursing staff, does case-based learning compared to the traditional didactic approach improve perceived confidence in critical thinking abilities over a 4-week period?

The key search terms I will use to narrow down my search are: “case studies” “critical thinking” “case-based learning” “nursing education”

I appreciate any and all feedback on my proposed PICOT! Thanks!

Kendall

NR 621 Education Practicum Project Ideas

Reference

Yu, Z., Hu, R., Ling, S., Zhuang, J., Chen, Y., Chen, M., & Lin, Y., (2021). Effects of blended versus offline case-centered learning on the academic performance and critical thinking ability of undergraduate nursing students: A cluster randomized controlled trial. Nurse Education In Practice, 53, 1-8. https://doi.org/10.1016/j.nepr.2021.103080

Roman Voytkiv

Jul 7, 2021Local: Jul 7 at 7:33pm Course: Jul 7 at 8:33pm

Professor and class,

The education issue I want to focus on during this practicum course is bedside report. Bedside report is often done outside of patient rooms, nurses miss key information, and is unorganized. In this course I want to focus on creating ways for nursing students and new nurses to learn how to properly complete bedside report and include key components in an organized manner. Some educational intervention I would use to achieve my goal would be lab simulations, student role playing and lecture/power point presentations. These educational interventions will allow the students to learn proper bedside report in a classroom setting and then practice with other students and in simulations.

Picot question:

In nursing students and new nurses will simulation and direct instruction for bedside report as compared to PowerPoint lecture improve assessment scores in eight weeks?

Collapse SubdiscussionAbigale Caracci

Abigale Caracci

Jul 9, 2021Local: Jul 9 at 8:29am Course: Jul 9 at 9:29am

NR621/622 PICOT Worksheet – Week 1

Name: Abigale Caracci

Date: 7/9/2021

Your Instructor’s Name: Dr. Leigh Bonney

Purpose: To identify an issue that can be addressed by a nurse educator and develop a PICOT question to guide an evidence-based change project.

Directions: Use the form below to formulate a PICOT question. This includes filling in the table with information about your educational issue and your PICOT elements.

NR 621 Education Practicum Project Ideas

PICOT Question

The practice issue is new graduate nurses lack of confidence when entering the unit to become regular staff. The scope of this issue is personal experience. I know this feeling when I was a new graduate nurse and now as a preceptor for my unit. I see the same confidence issues that I used to possess in my orientees and this needs to be addressed now. New graduate nurses are timid in orientation classes and are not asking questions. They are uncomfortable answering questions in class because of low confidence. They wish to pretend they all know what they are doing. This causes them to either burnout out quickly or make mistakes on their new unit once they arrive.

The use of orientation for new graduates includes hospital orientation and an evolving nurse residency program at my hospital. The program is beginning to implement many avenues of learning in order to reach all types of learners. Multiple types of simulation are being introduced as well as powerpoint presentations, webex presentations, tests, and skills check offs. I believe the evidence is overwhelming for the need for change. Nurses on my unit are burning out constantly and leaving the unit. The new graduate nurses are seeing this and already they are speaking about looking for other positions. I believe through many avenues of simulation; the new graduates will feel confident entering their units and be able to become leaders. This increase in new graduate nurse confidence will lead to prevention of burnout due to stress, the ability to share their ideas from school (evidence-based practice) with confidence, and the ability to critically think when on the unit without being afraid of being wrong.

Formulating the PICOT question — Define each element of the question below:

NR 621 Education Practicum Project Ideas

P- Population and problem – What is the educational or clinical issue or problem and who does it affect?

Low confidence in new graduate nurses, affecting all staff on their units including themselves.

I- Intervention – What evidence-based solution for the problem would you like to apply? For most nurse educator students, this will be an instructional method or strategy

The use of multiple simulations in the orientation and nurse residency program.

C- Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or an alternative solution.

The other solution is to rely on the new graduates to perform with confidence without support.

A learner satisfaction survey will be given to the new graduates at the completion of orientation and after each nurse residency meeting to gauge the success of the intervention.

T- Time frame – For the purpose of NR621/622, this will be short-term. You won’t have time to examine NCLEX® scores or retention of new graduates, for example.

The time frame is their new nurse orientation and the beginning of their nurse residency over four to five weeks.

Then state your project question here in the form of a PICOT question (i.e., stick to the PICOT question format:

New graduate nurses will use simulation rather than no intervention, to improve confidence during their new nurse orientation and nurse residency.

Search terms you will use/How will you narrow your search?

Simulation, simulation to improve confidence, simulation for new graduate nurses

Instructor comments:

Approved/Date:

Elana Yuko

Jul 11, 2021Local: Jul 11 at 10:15am Course: Jul 11 at 11:15am

I think this is a very good thing to implement and research as I precepted many new nurses who lacked confidence. I think anything we can do to help improve confidence and patient care is important! The one thing I would recommend to you is phrasing your PICOT as more of a question rather than a statement as it is now. For example maybe something like, “Will using simulation rather than no intervention in new graduate nurses during their 5 week new nurse orientation improve confidence?”. I would also include the actual time frame of the orientation whether it is 4 or 5 weeks like I included. I hope this helps! Best wishes to you as you research and implement!

Sherill Foster

Jul 11, 2021Local: Jul 11 at 7:06pm Course: Jul 11 at 8:06pm

Hi Abigail,

I am a big fan of simulation and i believe that repetitive practice will definitely increase new graduate RNs confidence. But I believe that your picot questions needs a revision. During RN orientation or residency, they are oriented or trained at bedside and give direct patient care. How about removing the “no intervention” and replace with the training you do for new hire nurses, like direct patient care or direct bedside care. And also add a timeline, it can be for weeks or the whole clinical orientation. We have a new hired nurses that we train straight at bedside and sometimes patient are scared because they can tell they are new and asking the preceptor what to do in-front of the patient. Simulation training will help them become confident in performing skills prior to doing it with the patient. Good job with creating your picot question and recognizing this is an issue.

Lill

Collapse SubdiscussionMilagros Gonzales

Milagros Gonzales

Jul 9, 2021Local: Jul 9 at 10am Course: Jul 9 at 11am

PICOT Question

NR 621 Education Practicum Project Ideas

The Covid-19 pandemic has forced new grad nurses to apply for jobs with little to no clinical experience. This has caused a bit of havoc on the units as the simple interaction between nurse and patient has not even occurred for these new nurses. Often times these new nurses are not comfortable with placing themselves in the nurse role and addressing their patient appropriately. Their lack of clinical experience also resulted in learning skills such as medication administration and head to toe assessments. This has lead for many new nurses to become overwhelmed and stressed when orienting to their new role so much that they end up terminating their employment before or shortly after orientation is completed.

Formulating the PICOT question — Define each element of the question below:

P- Population and problem – What is the educational or clinical issue or problem and who does it affect? New nurses in hospitals and their desire to stay after orientation is completed

I- Intervention – What evidence-based solution for the problem would you like to apply? For most nurse educator students, this will be an instructional method or strategy.

Interventions implemented by professional development such as mentorship, residency, and orientation.

C- Comparison – What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or an alternative solution.

No interventions implemented

New Nurse satisfaction and retention after orientation.

T- Time frame – For the purpose of NR621/622, this will be short-term. You won’t have time to examine NCLEX® scores or retention of new graduates, for example. Eight weeks

Then state your project question here in the form of a PICOT question (i.e., stick to the PICOT question format:

In new graduate nurses, how do staff retention techniques implemented by educators and managements compare to no interventions affect retention in new hires?

NR 621 Education Practicum Project Ideas

Search terms you will use/How will you narrow your search?

Retention rates in new graduate nurses

Nurse burnout

New nurse residency program

Mentor Programs for New nurses

This issue is far greater especially since many new nurses are overwhelmed with entering the professional world with almost little to no clinical experience. For this reason, I will narrow my search to be within the last two years to the best of my ability.

Instructor comments:

Approved/Date:

Melissa Pellot

Jul 11, 2021Local: Jul 11 at 2:49pm Course: Jul 11 at 3:49pm

Milagros,

Thanks for sharing your excellent topic! This was not something I had originally even thought about over the past year as I work in an outpatient setting but wow what a huge issue. Not only for retention and burnout but for patient safety. Back in the day when I was a new graduate, I barely felt comfortable with the amount of experience gained from clinicals. I can not imagine not having any experience. I wonder if within the PICOT question it might be a good idea to narrow your focus to a specific intervention, such as new nurse residency OR orientation. This may help with your research.

-Melissa

Leigh Bonney

Jul 9, 2021Local: Jul 9 at 12:40pm Course: Jul 9 at 1:40pm

Hello everyone,

I hope you all are feeling good about your first week in the course. It is always good to speak with you and your mentor, and I have enjoyed my 3-way calls this week. If you have not signed up for a 3-way call, please see the announcement and click on the link to the Google doc to set up a day and time.

Also, when I respond to student’s responses, it behooves all of you to read my responses to your peers. I will not respond to EVERY student. What I respond to your peers, you can apply to your project.

NR 621 Education Practicum Project Ideas

Your learning agreement is due this week. You will work with your mentor to develop this document. There is a table with 4 columns. You do not need to write the outcome. Those are already written for you and are in column 1. In column 2, you will revise the outcome, so it is specific to your practicum site. So, for course outcome 1, CO1. Prioritize high quality, safe, patient-centered care when working with learners. (PO 1, holistic health & patient-centered care). You will write in the 2nd column – I will prioritize high quality, safe, patient-centered care when working with learners at Spoon River College. That’s it – done. Now, in the 3rd column, you and your mentor need to determine how you will achieve that outcome. You could state in the 3rd column, I will will present a case study on phlebitis following IV insertion in a medical-surgical unit.

Remember, this is an educator evidence-based practicum project. You are researching teaching strategies. You will research the intervention which should be an innovative teaching strategy such as casestudies, role playing, simulation, and the flipped classroom.

I hope this helps.

Sincerely,

Dr. Bonney

Melissa Pellot

Jul 10, 2021Local: Jul 10 at 5:13pm Course: Jul 10 at 6:13pm

Professor and Class,

First year ADN students are at the base of Blooms Taxonomy, remembering and understanding new knowledge. Due to the short timeframe of an ADN program and the vast complexity of learning needed to take place by graduation, it is imperative to start developing critical thinking skills starting in the first semester. Nurse educators must develop learning strategies to promote these skills to provide quality outcomes for patients. Unfolding case studies is a strategy to help student’s synthesis/recall memorized information and apply knowledge to realistic patient scenarios in a safe environment. By collaborating with their peers when answering questions, they are able to apply foundational knowledge while reflecting on different points of consideration when assessing and evaluating a patient care plan. This allows learners to take a more active role in their learning; essential to development of crucial thinking.

P- First year ADN students having difficulty with development of critical thinking skills

I- Implement use of unfolding case studies and test taking strategies within the class setting

C- PowerPoint lecture

O- Improved course exam scores.

T- At the end of the foundation course.

In first year ADN students, will the use of unfolding case studies and test taking strategy tips compared to PowerPoint lecture, improve critical thinking skills as evident by improved exam scores by the end of the foundations course?

-Melissa

Leigh Bonney

Jul 10, 2021Local: Jul 10 at 7:06pm Course: Jul 10 at 8:06pm

Discussion Summary Post:

In this week one discussion, you described the nursing education issue that you will address for your educator practicum project. There were both academic and professional nursing development ideas involving mentors and preceptors. There is a growing concern for nurses entering into the profession and properly preparing them for practice. In academia, critical thinking is an issue. Students need to increase their clinical reasoning, and teaching strategies such as unfolding case studies and simulation can help increase clinical reasoning for students.

NR 621 Education Practicum Project Ideas

You explored evidence-based practice educational intervention (teaching methodology) you propose. Evidence-based teaching strategies are the focus of your search. The intervention is what you will search in your literature search. Evidence-based teaching strategies such as case studies, role playing, and simulation are just some of the teaching strategies that will improve quality of education. You will explore how this educational intervention will help the nursing education issue. You provided your PICOT question using the standard PICOT format. This will guide you as you explore the literature for your week 2 assignment.

This is an excellent opening to the course!

Have a great weekend,

Dr. Bonney

Sherill Foster

Jul 11, 2021Local: Jul 11 at 6:48pm Course: Jul 11 at 7:48pm

Hello Class,

Interpreting ECG strips are sometimes difficult for experience RN’s let alone for new hired graduate RN or experienced RN’s working in Med-Surg unit that does not require a Tele in the unit. In current hospital I work, we conduct nee hired 2 days ECG classes. It is a didictal style class and an assessment by the end of second day. To be competent in interpreting ECG strips needs repetitive practice. It is hard to determine if the RNs are learning with 25 or more people in the class. I believe that this intervention needs to be change in order for our new lire RNs can easily learn how to interpret ECG strips, be able to recognize changes in patient con condition and intervene immediately to prevent patient decline. a ECG simulation and One-on-one education would be beneficial for new hired RNs.

PICOT question:

P – population: New hire Registered Nurses, new graduate nurses

I – intervention: ECG simulation and one-on-one education

C – comparison: 2 days didactal lecture

O – competent in interpreting ECG strips

T – time: 8 weeks

In new hired Registered Nurses, does ECG simulation and one-on-one education compared to two days didactal lectures can increase RNs competency in interpreting ECG strips in 8 weeks?

I will narrow my search by searching: ECG simulation, new hires ECG education, ECG one-on-one education. ECG didactal classes.

There are a lot of work needs to be done, I appreciate your critics and suggestions.

Lill

NR 621 Education Practicum Project Ideas

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Essay NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

NR 621 Education Practicum Project Ideas

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