NUR 685 Module 2 Needs Assessment Paper Example

A Learning Needs Assessment of Sepsis Recognition and Escalation Among New Graduate Nurses

[Student Name]

Southern New Hampshire University

NUR 685: Nurse Educator Capstone

Module Two Needs Assessment Paper

[Instructor Name]

[Date]

A Learning Needs Assessment of Sepsis Recognition and Escalation Among New Graduate Nurses

Educators are tempted to begin with content: what should learners know? A needs assessment begins instead with performance: what do learners do now, what should they do and why is there a difference? This paper assesses the learning needs of new graduate nurses enrolled in Lakeshore Regional's residency, a composite hospital program, in recognizing and escalating early sepsis. It describes the learners, the data sources, what each source showed and how the findings were organized, and it ends with learning needs stated as behaviors the teaching must change.

The Learners

The current cohort includes 38 registered nurses in their first year of practice, 30 on medical-surgical units and eight on step-down units. Most completed baccalaureate programs within the past twelve months; six are second-career nurses. All attend monthly residency sessions and work with a preceptor for their first twelve weeks, after which they practice independently, many on night shift, where fewer senior nurses and providers are present.

Data Sources

Five sources were used so that no single view would dominate. A chart review by the quality team examined 60 sepsis cases on medical-surgical and step-down floors over nine months. An anonymous survey of the cohort, answered by 33 of 38 residents, asked about confidence in recognizing sepsis and in calling a provider. A focus group of eight residents explored what happens between noticing a change and escalating it. Interviews with six preceptors gathered their observations. And an item analysis of the existing sepsis post-test showed which questions residents answered correctly.

What the Data Showed

The chart review found that residents documented abnormal vital signs promptly, usually within the hour, yet with a first-year nurse at the bedside, the typical wait between the patient meeting screening criteria and a provider hearing about it stretched to about two and a half hours, more than double the wait with seasoned nurses. In a third of resident cases, a second set of vital signs was taken and documented before anyone was called.

The survey showed high confidence in knowing the sepsis criteria, with 85% agreeing or strongly agreeing, but much lower confidence in deciding when to call a provider at night, at 39%. In the focus group, residents described waiting for a second abnormal reading to be sure, worrying about being wrong and not wanting to wake a physician for what might be nothing. Preceptors confirmed that residents rarely escalated on their own during orientation because preceptors usually made the call. The post-test item analysis showed that residents answered recall questions about criteria correctly more than 90% of the time, but only 58% chose the right action in the one question that presented a patient with borderline findings.

Table 1. Summary of Needs Assessment Findings

Note. Figures are illustrative for the composite program.

Organizing the Findings with Tanner's Model

Tanner (2006) synthesized research on how nurses make clinical judgments into a model with four linked phases. Noticing is grasping the situation, shaped by the nurse's expectations and knowledge of the patient. Interpreting is making sense of what was noticed, whether through pattern recognition or analytic reasoning. Responding is deciding on and taking action. Reflecting, both during and after action, feeds learning back into future judgments. She emphasized that judgment is influenced as much by what the nurse brings, including experience and values, and by the unit's culture as by the objective data.

Placed on this model, the residents' gap is clear. Noticing is largely intact: they record the abnormal vital signs. Interpreting is fragile when findings are borderline, as the post-test item shows. Responding is where the delay lies, shaped by self-doubt and a unit context in which preceptors made the calls. Reflecting is rarely supported, since no one reviews missed or late escalations with residents.

Why Residents Hesitate

In her study of newly licensed nurses, Duchscher (2009) used the term transition shock for the early months when novices feel the full weight of responsibility for the first time, doubt their competence and are acutely sensitive to how experienced colleagues and physicians respond to them. The residents' focus group echoed this closely, especially the fear of calling a physician unnecessarily. The implication for teaching is that knowledge is not the missing ingredient; confidence and rehearsal in deciding and acting under uncertainty are.

Priority and Consequence

The gap deserves priority because delay in sepsis carries measurable harm. Seymour et al. (2017) found that longer times to complete initial sepsis care, and to give antibiotics in particular, were associated with higher in-hospital mortality. An extra hour between recognizing criteria and alerting a provider delays every step that follows.

What Is Not a Learning Need

Not every part of the gap can be solved by teaching, and a needs assessment should say so. Two findings point elsewhere. Preceptors making most calls during orientation is a feature of the preceptor role, which is better addressed through preceptor development than resident education. And the focus group's worry about waking physicians reflects a unit culture that the education department cannot change alone. These findings will be shared with the residency coordinator and the medical staff's quality lead, while the capstone focuses on what teaching can reach: interpretation, escalation and reflection.

Learning Needs

The assessment yields four learning needs stated as behaviors. Residents need to interpret borderline presentations using the screening criteria and trends rather than waiting for a second reading. They need to escalate to a provider promptly when criteria are met, using a structured report. They need to rehearse these decisions under realistic pressure, including at night with an unfamiliar provider. And they need structured opportunities to reflect on their decisions with feedback. These needs point toward simulation with debriefing rather than more lecture content.

Conclusion

The residents know the criteria but do not yet act on them with confidence. The needs assessment locates the gap in interpreting and responding, explains it through transition shock and shows that it matters for patients. The next milestone turns these needs into measurable objectives.

References

Duchscher, J. E. B. (2009). Transition shock: The initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 65(5), 1103-1113. https://doi.org/10.1111/j.1365-2648.2008.04898.x

Seymour, C. W., Gesten, F., Prescott, H. C., Friedrich, M. E., Iwashyna, T. J., Phillips, G. S., Lemeshow, S., Osborn, T., Terry, K. M., & Levy, M. M. (2017). Time to treatment and mortality during mandated emergency care for sepsis. New England Journal of Medicine, 376(23), 2235-2244. https://doi.org/10.1056/NEJMoa1703058

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04