“A learning needs assessment is a systematic approach to studying the state of knowledge, ability, interest, or attitude of a defined audience or group involving a particular subject” (University of Idaho, 2009, p. 3). There are two goals for a learning needs assessment. The first goal is learn what the target audience already knows, and the second goal is understand what can be done to make teaching the target audience successful (University of Idaho, 2009). On the pulmonary step down unit at Christiana Care Hospital Newark campus a learning needs assessment was conducted on if nurses knew how to perform proper mouth care on ventilator patients.
Type of Institution
Christiana Care Health System is one of the country’s largest hospitals. This health system is ranked 17th in the nation for hospital admissions (Christiana Care Health System, 2012). Christiana Care Health System has two campuses located in Delaware. The smallest campus that is also the headquarters is located in Wilmington, Delaware, and the largest campus is located in Newark, Delaware. This health system is a teaching, not-for-profit level one trauma center with more than 1,100 patent beds. Christiana Care employs more than 10,000 people, making the hospital the largest private employer in Delaware.
Nursing Services Provided
In 2010, Christiana Care Health System joined the nation’s elite. The “health system achieved Magnet recognition for excellence in nursing by the American Nurses Credentialing Center” (Christiana Care Health System, 2012, para 2). The nursing care provided at Christiana Care is among the top 6% in the nation. Nursing care is provided in various settings throughout Christiana Care Health System. Nurses at Christiana Care hold more than 10 different roles in nursing. These roles range from the bedside nurse, to staff development specialist, to chief nursing officer. On the pulmonary step-down unit at Christiana hospital there are more than 70 nurses employed. The nurses provide care to patients with chronic pulmonary illness. The diagnosis range from patients with chronic obstructive pulmonary disease to patients with Amyotrophic lateral sclerosis and are ventilator dependent. The nurses are responsible for educating the patients as well as the families on the illness and on how to care for themselves or their loved ones after discharge from the hospital.
Volume of Activity
Being among the largest hospitals in the country, Christiana Care Hospital sees a large amount of patients. In 2011, Christiana Care Hospital had 166, 945 emergency room visits with 52, 884 patients being admitted. There were 531, 483 out-patient visits conducted and 279, 740 home health care visits. 6,641 babies were delivered, and 1,200 were in the neonatal intensive care unit. 40,220 surgical procedures were performed, 806 open heart surgeries, and 319, 744 radiology procedures (Christiana Care Health System, 2012). This work as accomplished by 10, 477 employees, 1,447 medical-dental staff, 255 medical-dental residents and fellows and 1,206 volunteers.
Levels of Nursing Care Staff Employed
There are many levels of nursing employed at Christiana Hospital. Licensed practical nurses whom perform delegated tasks assigned by the registered nurse. Registered nurses whom perform patient care, which include education and collaboration with others of the interdisciplinary health care team. Advances practice nurses who are masters’ prepared nurses who can hold different titles with different job descriptions. These titles include nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists. These nurses function as expert clinicians, and provide clinical support (Christiana Care Health System, 2012). Staff development specialists assist the nurse manager is maintaining staff competence. Staff education specialists are master’s prepared nurses who help the department of nursing to assess, plan, develop, implement, and evaluate nursing development. Patient care coordinators assist the nurse manager in operations of the unit.
Nurse managers are responsible for the daily operation of the unit. They also resolve issues that arise with patients and families, and physicians, and staff. Vice Presidents manage the resources necessary to provide nursing care. Nursing Coordinators provide coverage after business hours, weekends, and holidays. Associate chief nursing officer is accountable for supporting the initiatives and goals of the department of nursing and assumes the role of the chief nursing officer in her absence. Last the chief nursing officer directs the delivery of nursing care, treatment, and services (Christiana Care Health System, 2012).
Educational Needs Assessment
A questionnaire with three questions was used to conduct this assessment. The questions are 1) how often do you perform mouth care on your vent patients? 2) How often are vent patients teeth to be brushed? 3) How long after you use the chlorhexidine during mouth care must patients remain npo (nothing by mouth)? This questionnaire was randomly handed out to 10 nurses in the pulmonary step down unit, ranging in age, years of nursing experience, and years of experience in the step down unit. All nurses had their bachelor’s degree in nursing, and all nurses worked the day shift when the mouth care is primarily done. One hundred percent of the nurses answered the first and second questions correctly, which were 1) every two hours and 2) every 12 hours. Only 20% of the nurses answered the third question correctly. The correct answer is two hours. Highest Educational Need. From the results of the assessment, the highest priority educational need is to teach the staff the importance of keeping the vent patients npo two hours after the chlorhexidine is administered. Ventilator associated pneumonia is a leading cause in death of vent dependent patients. Chlorhexidine reduces the incidence of ventilator associated pneumonia only if used properly (Wikipedia, 2012).
If food or drinks are used directly after a patient uses chlorhexidine the effects of the mouth wash is washed away. Christiana Care has clinical practice guidelines available for all staff to use on the intranet. There is a guideline on the intranet about mouth care for vent patients, and it discusses the need to have a patient remain npo after chlorhexidine administration. A few ways to reinforce the importance of this are in-services for the staff and visible posters to be hung in the staff break room. Management can include a short in-service on the correct use of cholorhexidine during the monthly staff meetings.
Since the unit already has a vent committee that group of nurses can work on a poster board to hang in the staff break room reinforcing what was taught during the staff meetings. Seeing and hearing information repeatedly helps with remembering. Even though this information is readily available on the intranet, staff was not using this resource enough to retain the correct information. By using repetition and seeing the information every day it will help drill the information into the staff. After a few months of the information being repeated during in-services and the poster board hanging up in the break room, an evaluation can be conducted to see if these methods have worked.
During the learning needs assessment on a pulmonary step down unit at Christiana Care Hospital it was discovered that nurses were not aware of the correct length of time a patient is to remain npo after chlorhexidine administration. The use of this mouthwash is one important way to prevent a patient from getting ventilator associated pneumonia, which is a leading cause of death for vent dependent patients. Teaching strategies of monthly in-services and a poster board are ways to remind the staff of the importance of using the medication correctly. To evaluate if these strategies worked another questionnaire will be handed out a few months later.