The practicum learning agreement created between the masters of Science in nursing (MSN) student and the instructor was approved for the goal to perform in the role of a nurse educator at the Domiciliary Rehabilitation Program at the Orlando Veterans Affairs Medical Center (VAMC). The population of the Domiciliary Residential Rehabilitation Program is veterans with multiple and severe medical conditions, mental illness, addiction, or psychosocial deficits. Military-related posttraumatic stress disorder (PTSD) can negatively affect the veteran’s well-being (Health Services Administration, 2010). The care needs of the nursing staff were assessed to identify the need for the educational program in the rehabilitation program. Further development, implementation and evaluation of a program to improve the veteran’s quality-of-life were the objectives to provide the best outcomes of a teaching/learning program.
The learning agreement included the strategies to accomplish the objective with an established time-line and self-reflective journal to meet the best outcomes. Professional relationships were established with a mentor and networking with the organization improved professional advancement capabilities at the Orlando VAMC. Evaluation of the effectiveness of the project produced positive outcomes to improve the veterans’ quality of life. The role of a leader used evidence-based decision-making and applied ethical standards. The importance of nursing theory provided the principles to generate nursing knowledge and create practices to help the veterans who are affected by PTSD. The practicum experience enhanced the role as a nurse educator to improve cost-effective nursing practices for the veterans at the VA Medical Center.
Effectiveness of Project
The project began with an idea using a practicum project brainstorm worksheet (Appendix A). The learning objectives were established, and a timeline was used to maintain a deadline for completion (Appendix B). Each learning objective used Bloom’s taxonomy for three learning domains: cognitive/knowledge (mental learning), affective/attitudes (growing feeling learning) and psychomotor skills (manual/physical learning) (DeYoung, 2009). The first learning objective analyzed peer-reviewed literature and evidence-based research to identify the disease process and formulation of best practices (Burns & Groves, 2009). An extensive reference base was conducted and used to draft a needs assessment that was discussed with the mentor, mental health team, nurse manager, and educator (T. Russell, H. Ortiz, D. Hopson, personal communication, Summer, 2013). Their experienced feedback was practical in completing an effective outcome to the objective.
The next learning objective was to design the educational program using a PowerPoint presentation, hand-outs, knowledge test, and final evaluation. A teaching plan guideline with learning objectives followed Veteran Affairs Health Administration procedures for quality and performance (Orlando VAMC, 2013). A summary of the program was presented and approved by administration. Implementation of the learning program was coordinated with approval of management. A flyer was created to announce the class dates and times. All three shifts on the rehabilitation department were provided a verbal pre-test and lectured on the topic. Many opportunities for open-discussion helped the staff explore their own beliefs and experiences to improve their knowledge and skills.
The post-tests were scored and found a positive correlation to learning and accomplishing the program objectives. The VAMC evaluation tool was used to score the course and instructor. Self-reflective journaling helped to identify strengths and weaknesses of the program and teaching techniques used. The results were shared with the mentor who provided encouragement to learn from the experience and build knowledge of performing as an educator. The outcomes of implementing the teaching program was completed and found to be successful in improving nursing knowledge by providing evidence-based practice to enhance the veteran’s well-being.
A final evaluation of the practicum learning used the Orlando VAMC evaluation form. The teaching program method was appropriate for learners. A detailed reflective analysis in the portfolio included results from a final meeting with the mentor, administration, mental health team, and educator. All favored the educational program to improve nursing standards of care for veterans with PTSD in the rehabilitation program. Encouragement to expand the teaching to nursing staff on all mental health departments and in the orientation program for newly hired nursing personnel was made by the mental health chief nurse. The outcome had few strength and weaknesses in which to learn from. The weaknesses are personal areas of improvement that can be enhanced with continued experience as an educator, optional training aids available at the VAMC and continued evaluations for improvement. Another weakness of the project was the small learning experience as compared to the nursing population at the VAMC.
MSN Program Student Learning Outcomes
A quality assessment process from up-to-date journal reviews can provide the decision-making for new interventions in patient care. Evidence-based decision-making requires the integration of the best available research evidence addressing specific clinical questions (Kranke, 2010). A systematic review of literature was pooled to obtain data about PTSD issues. Prepared health professionals use evidence to inform safe practice and account for positive patient care outcomes are the aim for delivery of health care. Competence, education and skills play a critical role in achieving safe patient care in a complex health care system. Nursing professionals have the role to ensure the translation of evidence into practice while evaluating outcomes. The demand for improved patient care and a safe health care delivery system is taught at the University of Phoenix and the Veterans Health Administration. Nurses have a direct effect on patient care outcomes and quality (McLaughlin & Kaluzny, 2006). Influencing change is essential in any organization and a good change agent is required as a leader (Tomey, 2009).
Analyzing and identifying the need to implement an educational course to teach nursing staff how to better care for veterans with PTSD requires the collection of data, using the right tools, preparing objectives, and evaluating the process of change. Advance nursing education has helped to gain the skills to diagnose and plan positive change to improve patient care outcomes. The principles of successful leadership are important in affecting change. Leadership skills are necessary to drive and maintain change. Views on diversity can bring change to programs. Veterans bring their own set of beliefs and values to a diverse and multicultural environment. Providing relevant care is important for nurses to understand their own beliefs, culture and values as well as understanding the veteran’s views. Their rights to confidentiality and privacy are trusted by patients to be maintained by medical personnel. A code of ethics, moral philosophies and effective communication is learned in advance nursing education to help guide the decisions in meeting patient care needs (Burkhards & Nathaniel, 2008).
Theory provides the framework to structure and builds knowledge (Walker & Avant, 2005). Models can help to link research, education and practice. The change process is complex. Nursing practice theories provide the framework for interventions and prediction of outcomes. Theories can guide practices in nursing that focus on the difference and similarities in respect to human care. Nursing theory provides the foundation to assess, evaluate and plan interventions. A theoretical perspective can help to meet the challenges of health care delivery and provide guidelines for nursing practices (Fitzpatrick & Whall, 2005). Nursing theory is essential in nursing research, education, practice, and development. Nursing theory helps to decide what is known and what needs to be known. The benefits include better patient care, enhanced professional status, improved communication, and guidance for research and education. Because care cannot be measured, theory can analyze it. Nursing models and theory are beneficial to the nursing practice.
Development of Professional Nursing Career
The project provided the opportunity to perform as a nurse educator and gain experience for advancement in this specialty. Involvement with nurse administrators, the mental health team, the nurse educators, and adjunct staff provided valuable opportunities to network. My work on the practicum project has advanced to expanding the program I created and the formal invite to join the mental health and rehabilitation team. The educational program has also advanced best practices of nursing personnel to perform with higher knowledge and skills. Years of nursing experience, expertise knowledge in mental health and gerontological nursing and the learning experience gained from the practicum project exposed me to knowledge and skills to take responsibility in leadership and advance my nursing career to a management level in the near future.
The practicum project was a success in improving patient care for veterans who have PTSD at the rehabilitation program. The experience from achieving personal learning objectives was a rewarding experience. Performing as a nurse educator using evidence-based decision-making in creating and implementing a program at the Orlando VAMC was evaluated as effective and safe in teaching best practices. Leading and advocating for ethical principles, addressing diversity and applying theory contributed to full development of my professional nursing career. The practicum experience has provided the knowledge, skills and experience to further advance my career in professional nursing.
Burkhards, M.A., Nathaniel, A.K. (2008). Ethics & Issues in contemporary nursing (3rd ed.). Clifton Park, NY: Thomson Delmar.
Burns, N., & Groves, S. K. (2009). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence (6th ed.). St. Louis, MO: Elsevier. DeYoung, S. (2009). Teaching Strategies for Nurse Educators. Upper Saddle River, NJ: Prentice Hall. Fitzpatrick, J. J., & Whall, A. (2005). Conceptual Models of Nursing: Analyisis and application (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Health Services Administration. (2010, November). Veterans have unique needs: VA program to be specific to vets. Mental Health Management Advisor, 15(11), 126-128. Retrieved from CINAHL database Kranke, P. (2010, September). Evidence-based practice: how to perform and use systematic reviews for clinical decision-making, 27(9), 763-772. doi: 10.1097/EJA.0b013e32833a560a McLaughlin, C. P., & Kaluzny, A. D. (2006). Quality improvement in healthcare (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers, Inc.. . doi: Retrieved from Orlando VAMC. (2011, January 22). Quality management system (Medical Center Policy 00Q-12). Orlando, FL: VA Medical Center. Tomey, M. (2009). Guide to nursing management and leadership (8th ed.). St. Louis, MO: Mosby. Walker, L., & Avant, K. (2005,). Strategies for Theory Constructions in Nursing, (5th ed). Upper Saddle River, NJ: Prentice Hall.
Practicum Project Brainstorm Worksheet
This worksheet must be completed prior to the first class meeting for NUR/590A. Identify a goal for the practicum project and more than one potential project idea.
Practicum Goals: To perform in the role of nursing educator at the Orlando Veteran’s Administration (VA) Domiciliary (Rehabilitation) Program by assessing and identifying learning needs of nursing staff related to assessment of, and caring for, veterans with military-related post-traumatic stress disorder (PTSD). To develop, implement and evaluate a nursing educational program for nursing staff that will address these learning needs and hopefully improve quality of life for these veterans and their families.
Description of Project
Potential Mentor and AgencyDraft Objectives (completed in Week One class)
Project Idea # 1
PowerPoint presentation and lecture
Create a program to educate nursing staff to learn and understand how to care for veterans with PTSD at the rehabilitation center using classroom lecture with PowerPoint presentation for all shifts.Michele Reed, JD,MSN,RN Orlando VAMC-Conduct a review of literature to use evidence-based nursing practices -Design a teaching/learning plan using a PowerPoint presentation, handout and test -Implement the program to the nursing staff at the Rehabilitation Center -Evaluate the teaching/learning program and practicum experience
Project Idea #2
Self-learning guide and test
Create a program to educate nursing staff to learn and understand how to care for veterans with PTSD by developing a self-learning guide to PTSD care for veterans at the rehabilitation program.Michele Reed, JD,MSN,RN Orlando VAMC(Same as listed above)