Joy is a nursing student in a cardiac short stay unit at the Toronto General Hospital.

Her patient assignment for the day is Mr. Ketchum, a 61 yr. old male undergoing a Percutaneous coronary intervention (PCI) on the right transradial artery access. Joy has been reading Mr. Ketchums chart and found the following: Mr. Ketchum is a bakery owner He is an ex-smoker, has high blood pressure, normal BMI Family history of heart failure and hypertension. Mr. Ketchum lately has been experiencing chest pain on his left side, he describes this pain as a, squeezing sensation. Mr. Ketchums stress test was negative but his exercise echo test showed two zones of ischemia and some decreased anterior wall motion

Scenario

Mr. Ketchum is scheduled for a PCI at 0800. Joy is responsible for prepping Mr. Ketchum for the procedure. She needs to get the femoral artery and the radial artery site ready. Mr. Ketchum returns at 1200 and Joy gets report. She sees his PCI was on his right transradial artery, and Mr. Ketchum returns to the unit with a TR band clamp. After Mr. Ketchum relaxes on the unit, Joy conducts her cardiac assessment, vital signs, administers medications and clamp removal. After the procedure Joy needs to prepare a care plan for Mr. Ketchums discharge. Mr. Ketchums wife asks Joy to give her some discharge information for caring for her husband at home, including medications, and what daily activities he is capable of doing. She wonders about exercises, stress management and other preventative measures to avoid another PCI. Mr. Ketchums wife tells Joy that she feels very overwhelmed. Joys preceptor has asked Joy to do Mr. Ketchums discharge, which includes medication (Plavix), infection control, discussing improved lifestyle changes and a dressing change.

Objectives: To identify the role of the nurse in a short-stay cardiac unit during discharge post PCI To explore health teaching strategies for the patient and the family after a PCI To discuss techniques for improving lifestyle and reducing stress To explore CNO/BGPs related to the importance of health teaching and health promotion To develop an understanding of different clamps, including the protocol of removing a clamp Key Terms: Angiogram Plavix Clamp- TR Band Ischemia Exercise echo test

Content Theory: Health Belief Model

Health Belief Model: Based on the understanding that a person will take a health-related action if that person: 1. Feels that negative health can be avoided (avoid infection)

(Nursing Influencing Change, 2010).

2. Has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition 3. Believes that he/she can successfully take a recommended health action

Concept Definition Application Perceived Susceptibility: -It is the individuals assessment of their chances of getting a disease or condition -In this area, one should define the population at risk, risk levels, personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low. Perceived Severity -It is the individuals opinion of how serious a condition and its consequences are -Specify consequences of the risk and the condition Perceived Benefits -It is the individuals conclusion as to whether the advised action will reduce risk or seriousness of impact -Define the action to take (i.e. how, where, when) -Clarify the positive effects to be expected Perceived Barriers -It is the individuals opinion as to what will stop him/her from adopting the new action -Identify and reduce barriers through nursing reassurance, incentives, and assistance Modifying variables: -An individuals personal factors that affect whether the new action is adopted Cues to Action -Strategies that will start a person on the way to changing behavior -Provide how-to information, promote awareness, and reminders Self-Efficacy -Confidence in one's ability to take action -Provide health teaching and nursing guidance in performing actions (Health Belief Model, 2010)

Process Theory: Information Processing Model (Cognitive Learning Theory)

Process Theory Cognitive Learning Theory: Information Processing Model

-1st Stage in Memory Process: Learner gives attention to external stimuli (i.e. Patient gives attention to nurse educator during health teaching) -2nd Stage: Through the senses, information becomes registered -At this stage, consider the patients method of learning (i.e. auditory or visual learner) -3rd Stage: There is the encoding of information within short-term memory -The information may then be incorporated into long-term memory -For the learner, the information may be stored and then recalled using methods like imagery, since the information is organized in long-term memory -Stage 4: Depending on the way information is stored and registered, the individual will respond and act on what they have learned -This model emphasizes the learner to use their retrieval and retention processes -Through learning and education, the learner stores and listens to the presented information -Obtaining feedback or questioning and stimulating the group is a good way to help peers remember nursing knowledge and foster new knowledge by asking pertinent questions

-Information processing is a term used to describe in-depth thinking processes such as how people rationalize situations, how certain information is retained, as well as peoples reasoning processes and how thought processes are retained in memory -Important for health professionals because it is good to know the way in which information is received and transmitted, especially when teaching patients -The stages in this model make it easy to track learning and observe the transmitted information in the group as it is instilled and perceived by learners in the group

(Bastable, 2008)

-Assisting individuals to reprocess information helps people to identify their own errors and to correct them by focusing on necessary things that must be retained (Bastable, 2008) **LEVEL IV: N4P04 THEME PAGE **NOT INCLUDED IN POST TO GROUP THEMES DIMENSIONS OF PRACTICE Practitioner Educator Leader

Evidence-based practice Role development Power relationships Autonomy Accountability & responsibility Dimensions of Professional Practice Practice Standards General Systems Theory Patient-family-HCP Family systems Health care setting Models of practice Socialization of Role Counselling Negotiation Conflict management Cooperation/Collaboration (Intraprofessional & Interprofessional) Marketing of the Nursing Role Clinical care Critical reflection (on practice & learning) Self assessment, marketing, job search Use of theory Professionalism

Group process Facilitation Team Player Educational Theories Staff Development Learning environment

Leadership theories and principles Role development in multidisciplinary teams Nurses role in systems Health care system Organizational Systems Delivery Systems of healthcare

COMMUNICATON

SYSTEMS

ROLE

Dissemination of nursing knowledge

Delegation Political advocacy

PROFESSIONAL EVOLUTION

Learning needs assessment Learning theory Education strategies

Environmental assessments Policy development Planning delivery of care Politics of health care Decision making strategies

EVALUATION

Role Evaluation Self-Evaluation Effectiveness & efficiency of practice

Measuring learning

Quality measures (program/system risk management) Quality of work-life Performance evaluation of self and peers Decision making

**NOT ICLUDED IN POST TO GROUP**

Icebreaker Content Theory & Process Framework Explanation 1st component of theory: Perceptions and Modifying Factors Activity

2nd component of theory: Assessments

3rd component of theory: Likelihood of Action

Discussing the nurses role on a cardiac short stay unit during admission and discharge Health teaching strategies for the patient and family (BPG & Practice Standards)

Themes Targeted Learning Environment Group Process Team Player Use of theory Learning theory Education Strategies Educational theories Patient-Family-HCP Group Process Facilitation Patient-family-HCP Health care setting Models of practice Heath care system Socialization of Role Decision-making strategies Delegation Models of Practice Negotiation Dissemination of Nursing Knowledge Learning needs assessment Accountability & Responsibility Clinical care Learning needs assessment Planning delivery of care Clinical care Planning delivery of care Role development Education strategies Learning environment Planning delivery of care Counseling Marketing of the nursing role Dissemination of nursing knowledge Role development Practice Standards

(McMaster BScN Course Manual, 2010).

Discussing cardiac nursing assessment, lifestyle changes and preventative measures: Solutions & Actions Asking questions to stimulate memory recall (Process Theory)

Picking learning gaps to research, which stimulates Action (Process Theory) Data being synthesized and analyzed Assessing Group Performance (Teamwork) Retrieval of Feedback Verbal evaluation Facilitation Summary

Facilitation Synopsis Paper

Evidence-based practice Role development Evidence-based practice Counseling Health care setting Clinical care Learning environment Group Process Learning theory Stimulate recall Decision-making strategies Delegation Team Player Role Evaluation Performance evaluation of self and peers Measuring Learning Effectiveness & efficiency of practice Role evaluation Self evaluation Performance evaluation of self and peers Self evaluation Professionalism Critical Reflection on practice and learning Performance evaluation of self and peers Self-evaluation

Agenda: Week 1
Time 10:40 11:00 11:00- 11:50 11:50-12:00 Activity Introduction of Scenario, Course Themes, Process & Content Theory Discussion to determine learning gaps and objectives Evaluation of performance

Verbal Evaluation Questions:

1. Were the theories/models sufficiently explained and introduced? How well were they applied to the case content and the group process? 2. How well were the objectives and overarching goal addressed and identified? 3. Briefly explain the Health Belief Model. 4. What are 3 components of the Information Processing Model? 5. Did you find the scenario useful for future nursing practice? Any constructive criticism?

Agenda: Week 2
Time 08:30 08:45 08:45- 10:00 10:00-10:20 10:20-10:30 Activity Ice Breaker Discussion Care Plan Evaluation of performance

(Knowles, 1975)

Written Evaluation Questions: 1. Did you find that the learning objectives were thoroughly discussed, and were your learning needs adequately met? 2. Was the content theory (Health Belief Model) effective in organizing the case information, and was it applied effectively? 3. Did the Information Processing Model (process framework) stimulate your nursing knowledge/memory and was it effective in promoting information sharing/discussion? Was a comfortable atmosphere achieved and did it help with learning and group process? 4. Please list 2 areas, which require improvement. 5. Please identify 2 positive components in our facilitation (Knowles, 1975) Memory/Recall Questions for Process Theory (To be asked during facilitation-will be more to stimulate memory): -Do you remember any health teaching strategies that can be used when discharging a patient? What have you done in the past when receiving and discharging a patient on your floor? How is this different from what you learned in this session? -What kinds of tangible things or tactics have you used in the past to help explain the patients medications or certain procedures?

References Bastable, S.B. (2008). Nursing as educator: Principles of teaching and learning for nursing practice. Sudbury: Jones and Bartlett Publishers, Inc. Google Images. (2010). The Heart. Retrieved October 2 2010 from: http://www.google.ca/imgres?imgurl=http://darbelofflab.mit.edu/files/heart.gif&imgrefu rl= Health Belief Model: Chapter 4-Jones and Bartlett Publishers. (2010). Retrieved October 5, 2010 from http://www.jblearning.com/samples/0763743836/Chapter%204.pdf Knowles, M. (1975). Self-directed learning: A guide for learners and teachers. Parisppany, NJ: Pearson Learning McMaster University BScN Course Manual. (2010). N4P04/N4Q04 Advanced Nursing Concepts I &II. Nursing Influencing Change: Health Belief Model Image. (2010). Retrieved October 5, 2010 from http://www.nursing-informatics.com/N4111/change_theories.html University of Twente. (2010). Health Belief Model. Retrieved October 5, 2010 from http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Health%20Commun ication/Health_Belief_Model.doc/