Educating Nurses: A Call for Radical Transformation by Patricia Benner & Molly Sutphen & Victoria Leonard & Lisa Day & Lee S. Shulman

Author:Patricia Benner & Molly Sutphen & Victoria Leonard & Lisa Day & Lee S. Shulman [Benner, Patricia & Sutphen, Molly & Leonard, Victoria & Day, Lisa & Shulman, Lee S.]
Language: eng
Format: epub
ISBN: 9780470457962
Publisher: Jossey-Bass
Published: 2009-12-09T00:00:00+00:00

What-If Rehearsing and Knowledge for Practice

Pestolesi creates opportunities for student to rehearse, drawing on their knowledge to make decisions in the face of ambiguous, open-ended clinical situations. She coaches her students to see and understand the nature of the context of the patient’s current clinical condition, the immediate history, the most urgent current concerns, and why they are urgent or salient.

Pestolesi describes how she reinforces and deepens students’ learning and sense of salience through such opportunities to rehearse decisions:

Jennifer is a good theory [classroom] student and based on how she prepared for clinical I had a pretty good idea that she was very strong. She always had the right answers without my having to prompt her. . . . She’d draw correlations between complex pathophysiologic processes that are affecting the patient’s presentation.

She was at the head of the bed, describing what interventions would be appropriate for her patients . . . I thought, “I’ll give her a harder scenario.” Her patient in the CCU that day was somebody who was mechanically ventilated, had a pacemaker, who was put on C-Pap because they’re trying to wean him from the ventilator. The patient had an insulin drip, and was having pacemaker problems and ventricular tachycardia problems as well.

I said to her, “So, Jennifer, you get back from break, your patient, who has been pretty much unstable all day, kind of motions towards his chest . . . indicating some kind of discomfort or pain. You look up at the monitor and right in front of you, you see that he has gone into this.” I put the rhythm on the screen, that little simulator. “That would sustain ventricular tachycardia. What are you going to do”

Jennifer said, “Well, I would solicit help, activate ACLS. So I press the code blue button over the head of his bed and I’d be thinking, [primary] A, B, C, D survey. Airway, he’s got his airways protected, he’s on a vent. However, he’s on C-Pap. . . . Well, C-Pap doesn’t give him a rate, so I give him a rate but better yet, I take him off the ventilator, attach him to an ambu bag and begin to manually ventilate him to maximize his oxygenation.”

I’m thinking to myself, “She’s really got it going.” Then she proceeded to lead him right through the pulses V Pack, ventricular fibrillation, ACLS algorhythm, without missing a beat. Also including in the fact that this gentleman had a pacemaker and that that could have misfired and caused the V Tach to be set off...and this was spontaneous, too. When she said to me at the end of the day, “I was wondering if I could take my summer preceptor experience in the ICU,” you can imagine what my answer was: “They would be happy to have you there.”