NUR 685 Module 9 Final Project Example

From Knowing to Calling: A Simulation Course to Improve Early Sepsis Escalation by New Graduate Nurses

[Student Name]

Southern New Hampshire University

NUR 685: Nurse Educator Capstone

Module Nine Final Project

[Instructor Name]

[Date]

From Knowing to Calling: A Simulation Course to Improve Early Sepsis Escalation by New Graduate Nurses

Abstract

New graduate nurses in a composite hospital residency averaged 88% on a sepsis post-test, yet a review of 60 floor cases showed they took about 2.4 hours from a patient meeting screening criteria to notifying a provider, compared with 1.1 hours for experienced nurses. Assessment traced the delay to shaky interpretation of borderline signs and reluctance to act on them. In place of the old lecture, the project offers a half-day simulation course of three scenarios and structured debriefings, designed from adult and experiential learning theory and the evidence on effective simulation. Evaluation measures reasoning with a case-based test, performance in simulation with an adapted clinical judgment rubric and time to call and floor practice through chart review, with fidelity checks and an explicit limit on the use of scores.

The Learning Gap

Sepsis kills when care is late. Seymour et al. (2017) studied tens of thousands of patients treated under a New York mandate and showed that hospital death rates climbed as the first hours of sepsis treatment, antibiotics above all, took longer to deliver. Floor nurses are often first to see the signs, so the minutes between recognition and escalation matter.

In the residency, those minutes were being lost. Five sources, a chart review, a survey, a focus group, preceptor interviews and a post-test item analysis, told a consistent story: residents noticed and documented abnormal vital signs, knew the criteria and scored well on recall questions, but they hesitated with borderline findings, rechecked before calling and felt unsure about waking a physician at night. Duchscher (2009) described this period as one of transition shock, when new nurses feel the full weight of responsibility and doubt their own judgment. The gap was not knowledge but confident action under uncertainty.

Objectives

Five objectives target the gap at the right levels. After the course, residents will identify that screening criteria are met in a borderline simulated case within five minutes, judge whether a trend supports escalation, call the provider within ten minutes of criteria being met using a structured report, prepare for first-hour orders and afterward critique the moment they chose to act and commit to one change. The objectives sit at applying, analyzing and evaluating on the revised taxonomy and at showing how and doing on Miller's pyramid, so they are assessed through performance rather than recall.

Theoretical Foundation

Taylor and Hamdy (2013) reviewed adult learning theories for health professions education and argued that educators should select theories that fit their learners and goals. Three shape this course. Andragogy explains why residents learn best from real problems, so scenarios are built from anonymized versions of their own near misses. Kolb's experiential cycle gives each scenario and debriefing its rhythm of experience, reflection, generalization and trial, repeated three times. Transformative learning explains why a scenario in which waiting leads to deterioration can unsettle the belief that rechecking is always safer. Because new graduates are vulnerable, every resident succeeds in an earlier scenario before facing that challenge.

Instructional Design

Issenberg et al. (2005) reviewed high-fidelity simulation research and identified features linked to effective learning, with feedback first, followed by repeated practice, integration into the curriculum, a range of difficulty and clear outcomes. The course builds in each. Groups of six residents complete a short briefing on the screening tool and structured report, then three fifteen-minute scenarios of rising difficulty: a daytime pneumonia with borderline findings, a night-shift urinary source with a curt, unfamiliar physician on the phone and a rapidly deteriorating patient. Each resident leads at least one scenario. A forty-minute debriefing follows each, and preceptors are briefed so they can reinforce the structured report on the floor.

Debriefing

Rudolph et al. (2006) argued that facilitators should neither hide their judgments nor deliver harsh critique, but should state an observation and an honest view and then ask about the learner's reasoning, uncovering the assumptions behind actions. Each debriefing moves through reactions, description, analysis and summary, with analysis following Tanner's phases of noticing, interpreting, responding and reflecting. Facilitators prepare observations in advance, such as a resident who rechecked vital signs for twenty minutes before calling, and invite the resident to explain the reasoning behind the pause. Ground rules protect confidentiality, and both facilitators complete debriefing training and calibrate on recorded scenarios.

Evaluation

The evaluation reaches three levels. Reasoning is measured with a ten-item case-based test of borderline presentations before and after the course. Performance in simulation is scored from video by two calibrated raters using the Lasater Clinical Judgment Rubric, adapted with sepsis-specific anchors, along with time to call in each scenario and a follow-up scenario at six weeks. Lasater (2007) built the rubric from Tanner's model in simulation and described it as a tool for feedback whose measurement properties needed further study, so the project gathers its own validity evidence and uses scores only for feedback and course evaluation. Practice is measured by setting chart-review escalation times from the two months following training against the prior cohort's times. A fidelity checklist records whether each debriefing followed the design.

Table 1. Evaluation Summary

Note. Satisfaction is collected briefly but not treated as an outcome.

Sustainability

If evaluation supports it, the course will replace the lecture permanently in the residency's fourth month. Scenarios, facilitator guides and the adapted rubric will be stored with the simulation center, two additional educators will be trained as facilitators and preceptor orientation will include the structured escalation report. The quality team has agreed to repeat the escalation chart review annually.

Limitations

The historical comparison cannot exclude other changes between cohorts. Numbers are small, and some residents may care for few septic patients in eight weeks. The rubric's validity evidence is preliminary and local. And simulation performance may partly reflect familiarity with the simulation center rather than judgment. These limits are reported with the results rather than hidden.

Conclusion

This project closes the educator's loop: it starts from a measured gap, writes objectives at the level the gap demands, lets theory and evidence shape the design, argues for the trustworthiness of its assessment and evaluates learning in practice rather than in the classroom. It moves residents, the course hopes, from knowing the criteria to picking up the phone.

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

Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Gordon, D. L., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(1), 10-28. https://doi.org/10.1080/01421590500046924

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04

Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There's no such thing as "nonjudgmental" debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49-55. https://doi.org/10.1097/01266021-200600110-00006

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

Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-e1572. https://doi.org/10.3109/0142159X.2013.828153