NU523 Unit 10 teaching project example

Forty-Five Minutes on Making the Call: A Teaching Project Report on Residents' Response to Advancing Opioid Sedation, With Partial Gains Reported Honestly

[Student Name]

Purdue University Global

NU523: Developing Instructional Strategies Using Theory and Evidence-Based Practice

Unit 10 Assignment

[Instructor Name]

[Date]

The residents, audit figures and session are composite and bracketed; the theory and guidance cited are published.

Needs Assessment

Two sources defined the need. Auditing the charts of [40] surgical patients on opioids whose nurse was a resident in her first four months showed that when a sedation score of 3 or higher was documented, the median time to a documented response, an opioid held, a provider notified or naloxone given, was 42 minutes. The unit's target, drawn from national guidance on monitoring opioid-induced sedation (Jungquist et al., 2020), is under 15 minutes.

A short anonymous survey of the fourteen residents asked why they might wait. Most gave the same answer: not uncertainty about the score, which they could rate correctly, but fear of being wrong, of waking a provider for nothing, or of being seen as unable to cope. The need was not knowledge but confidence in acting on knowledge they already had.

Objectives

1. Given a simulated patient with a sedation score of 3, the resident will place a call to the provider within five minutes.

2. The resident's SBAR call will carry four elements: the sedation rating, the breathing rate, the opioid given in the last hours and what she is asking the provider to do.

3. The resident will use at least one phrase of structured safety language when a provider hesitates.

Design

Because the need was confidence rather than knowledge, the session was built on self-efficacy theory. Bandura (1977) identified four sources of efficacy beliefs: mastery experience, the most powerful; vicarious experience, seeing someone similar succeed; verbal persuasion; and physiological states. The session used the first two deliberately, since another lecture would add knowledge the residents already had.

1. Minutes 0 to 5: each resident makes a two-minute recorded call to a facilitator playing a provider about a drowsy patient who scores 3, before any teaching. This is the baseline measure.

2. Minutes 5 to 15: a worked example. A recorded call by an experienced resident from the previous cohort, played and discussed: what she said first, what she asked for, how she handled a sleepy provider. Vicarious experience from someone at the same stage.

3. Minutes 15 to 30: structured safety language. Residents practice the three-step CUS escalation from TeamSTEPPS, stating concern, then discomfort, then naming a safety issue, for use when a provider hesitates (King et al., 2008).

4. Minutes 30 to 40: a second recorded call on a new patient, with a provider who pushes back once. Mastery experience, the strongest source of all.

5. Minutes 40 to 45: debrief and exit ticket.

Delivery

The session ran as planned with one exception. The simulation phone failed at minute 22, and ten minutes were lost while the educator switched to a mobile phone on speaker. The CUS practice was shortened to one round per resident instead of two. Two residents arrived late from the unit and missed the baseline call; their results are excluded from the before-and-after comparison, although both completed the second call.

Evaluation

Level 2, recorded calls. Twelve residents completed both calls. Scored by two facilitators on the four SBAR elements and the request, the median score rose from [2] of 5 at baseline to [5] of 5 on the second call. Ten of twelve residents placed the second call within five minutes of receiving the patient information, against five of twelve at baseline. On the second call, [nine] of twelve used a CUS phrase when the provider pushed back.

Level 3, chart audit. Sixty days after the session, a repeat audit of [38] residents' patients with a documented sedation score of 3 or higher found the median time to a documented response had fallen from 42 to [24] minutes. That is an improvement, and it has not reached the 15-minute target.

Level 1, reaction. Residents rated the session's relevance at [4.6] of 5, and [11] of 14 named the recorded calls as the most useful part of the session.

What the Recorded Calls Showed

Listening to the baseline calls was the most useful part of the project for the educator. Most residents opened with an apology, "I'm sorry to bother you," and several described the patient as "a little sleepy" rather than giving the score. Three never made a request; they described the patient and waited for the provider to decide. On the second calls, the apologies were mostly gone, the score came first, and ten of twelve ended with a specific request, such as holding the next dose, ordering naloxone or coming to see the patient. Those changes are small in words and large in effect: a provider woken at 0300 acts faster on "sedation score of 3, respiratory rate 9, I'd like you to see her" than on "she's a little sleepy."

Why the Audit Moved Less Than the Calls

The recorded calls improved sharply and the chart audit improved moderately, and the gap is instructive. A call in a seminar room, to a facilitator, with the scenario known, is not the same as a call at 0300 to an unfamiliar provider about a patient the resident has been told is "just tired." Residents also reported, in follow-up conversations, that on busy nights they documented the sedation score and then waited until they had finished other tasks before calling. The session addressed confidence; it could not address workload or the time it takes to find a covering provider. Documentation timing also blurs the audit: a resident who called promptly but documented later appears slower than she was.

Reflection and Next Steps

The project met its learning objectives and partly met its behavioral goal. Three changes follow. First, a second, shorter session at three months, with a recorded call in the unit rather than the seminar room. Second, a unit-level change: a standing order allowing nurses to hold the next opioid dose and apply oxygen for a sedation score of 3 without waiting for a provider, which removes one reason to delay. Third, a revised audit that records the time of the call from the paging system, not only the time of documentation. The closed claims literature on opioid-induced respiratory depression is a reminder of why the remaining gap matters: severe events have often followed documented sedation that was not acted on in time (Lee et al., 2015).

References

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191

Jungquist, C. R., Quinlan-Colwell, A., Vallerand, A., Carlisle, H. L., Cooney, M., Dempsey, S. J., Dunwoody, D., Maly, A., Meloche, K., Meyers, A., Sawyer, J., Singh, N., Sullivan, D., Watson, C., & Polomano, R. C. (2020). American Society for Pain Management Nursing guidelines on monitoring for opioid-induced advancing sedation and respiratory depression: Revisions. Pain Management Nursing, 21(1), 7-25. https://doi.org/10.1016/j.pmn.2019.06.007

King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2008). TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. In K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady (Eds.), Advances in patient safety: New directions and alternative approaches (Vol. 3). Agency for Healthcare Research and Quality.

Lee, L. A., Caplan, R. A., Stephens, L. S., Posner, K. L., Terman, G. W., Voepel-Lewis, T., & Domino, K. B. (2015). Postoperative opioid-induced respiratory depression: A closed claims analysis. Anesthesiology, 122(3), 659-665. https://doi.org/10.1097/ALN.0000000000000564