Teaching Methods(4.7.08)

IV Line Insertion Running head: TEACHING METHODS

Intravenous (IV) Line Insertion: Teaching Methods Aaron A. Almassy Ferris State University

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Abstract This document illustrates teaching methods to be used for class sessions regarding Intravenous (IV) line insertion. Key topics include examination of the lecture-discussion method, and the cooperative or group learning method. Rationale for the instructor’s choices of these methods will be provided throughout. Means to assure a positive and productive learning experience will be outlined and addressed. Additionally, evaluation tools and their importance will be examined.

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Intravenous (IV) Line Insertion: Teaching Methods Two teaching methods or instructional strategies will be used for imparting knowledge and skill regarding IV line insertion. These methods are: lecture-discussion, and hands-on practice/cooperative-group learning. Teaching IV insertion is an active-learning process, students will benefit from these varied instructional methods. Instruction will be rooted in the three domains of learning (cognitive, psychomotor, and affective domains). Students will be expected to meet the expectation of the objectives set forth for the learning module. We will explore the teaching methods that have been identified above, as well examining the resources needed to bring these methods to fruition. Approaches for a positive learning experience will be discussed. The evaluation process of students and instructor will be presented finally. Teaching Methods (Instructional Strategies) Lecture-Discussion A lecture-discussion session will be conducted first, a few days prior to the hands-on learning session, which will be presented. Lecture-Discussion is only one tip of a three pronged approach, here. As Bradshaw & Lowenstein (2007) state, the lecture is most effective when combined with other teaching strategies. Literature review assignments in the form of textbook reading along with student generated additional research will be provided. As with any instructional strategy, the lecture-discussion has advantages and disadvantages. The lecture-discussion will be necessarily utilized as a component of the overall teaching process here, to better, more fully reach the majority of students. The instructor would utilize the lecturediscussion method in order to enhance and clarify the reading material and clarify questions that arise as students conduct their own research. Resources that are needed for the lecture are few. First, the main component of the lecture is the lecturer with his or her strategies to effectively communicate with students (Bradshaw & Lowenstein, 2007). Another needful resource is the personal computer (PC) with Microsoft Power Point software. Power Point allows the instructor to engage his or her students visually, while lecturing. “Research reported in educational literature suggests that using visuals in teaching results in a greater degree of learning” (Stokes,

n.d.). Another needed resource is a supply of any literature to be handed out to students. Bradshaw & Lowenstein (2007) indicate that a skeletal outline should be given to students only if helpful for students’ identification of key points. They go on to state that if handouts are to be used, they should be clear and contain only a limited amount of information, also if they are printed on colored paper, they are more likely to be utilized by students (Bradshaw & Lowenstein, 2007). In this class, per Bradshaw & Lowenstein (2007) only a skeletal outline of the presentation will be provided to the students. The skeletal outline provides a nice way for students to follow along and make notations appropriately throughout the lecture. It also provides a means for students to note questions they have for the discussion portion of the lecture. Hands-on Practice/Cooperative-Group Learning First, in this session, a demonstration of an IV insertion will be provided by the instructor as an initial point of reference for the student. One purpose of the hands-on practice session is to develop fine motor skills as a component of the student’s psychomotor skills development (Billings & Hallstead, 2005). Fine motor skills are those required to perform procedures where accuracy and exactness are necessary (Billings & Hallstead, 2005). Cooperative or group learning will follow the demonstration, so that students can begin to practice what they have seen. As DeYoung (2003) states, cooperative learning is based on the idea that students work together and are responsible for one-another’s learning. Therefore, the class will be broken up into small groups of four students each. Each student will demonstrate for the group an IV insertion from beginning to end. The rest of the group will observe the demonstration, provide feedback and constructive criticism. The process then repeats for each subsequent group member. DeYoung (2003) refers to Infante (1985) when noting that “observation is an essential element of clinical learning” (p.238). Repetition is an important concept here; repeated rehearsal of the information/demonstration is a key to knowledge retention in the short term memory. Additionally, repetition helps the new short term memories continue long enough to transition to long term memories (Billings & Hallstead, 2005). There are numerous advantages to structuring

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a class session in this fashion. First, for nurses, group structuring represents an invaluable lesson because we need to be able to work collaboratively and effectively within the interdisciplinary team. Group work helps to achieve this (DeYoung, 2003). Second, group work enhances each member’s social skills (DeYoung, 2003). Another advantage to cooperative-group work is that it promotes the use and development of critical thinking skills, also very important for nurses to possess (DeYoung, 2003). DeYoung (2003) presents no disadvantages to cooperative learning. Additionally, Students learn best when they are actively engaged in the learning process. Analysts report that, students working in small groups are more likely to learn more of what is presented and retain it longer than when the same content is presented in other instructional formats (Gross-Davis, 1993). The only resources needed for effective group work are multiple students, with an assignment to complete or a new skill to learn. However, additional resources are needed for the actual practice environment. First, we will need access to the nursing skills laboratory. Next, we will require all necessary supplies for IV saline lock (SL) insertion, and mannequins or artificial upper extremities appropriate for IV insertion. Assuring a Positive and Productive Experience Lecture-Discussion In order to assure a positive and productive learning experience, students will be encouraged to ask questions and converse openly during the discussion period of the lecturediscussion. The utilization of questioning by the instructor is helpful in actively engaging students in the lecture (Daniel, 1999). Dissemination of content by the lecturer will be limited to approximately ten minutes, with following discussion. This is done partly because of appropriate time frames needed to explain the process in addition to attempting to control the students’ attention. The instructor as well as the other students will listen attentively to the questions and offer clarification and feedback as necessary. Utilization of this lecture method with discussion will increase student participation and likewise student experience (Billings & Hallstead, 2005).

The instructor will speak clearly and provide examples from his or her own current and past practice experiences. This recounting of personal experiences would fall under the strategy of modeling. As Billings & Hallstead (2005) state, “One way to help students learn…is through modeling” (p. 260). Faculty should consistently model desired performance and views that are integral components of nursing practice (Billings & Hallstead, 2005). Hands-on/Cooperative-group Learning During the initial presentation by the instructor, the students would be instructed to assume a position where each individual can clearly see and hear the presentation. This presentation will be especially useful for the visual learner, as these individuals learn best by demonstration (Cuyamaca College, 2003). Again, as in the lecture, students would be encouraged and prompted to ask questions to assure the comfort of the student in relation to the information presented. Questions to prompt critical thinking will be utilized by the instructor. One such question could be “why is the bevel of the needle pointed up for an IV insertion?” After the initial demonstration period by the instructor, the students break up into groups to practice what they have just seen. In order to assure a positive experience with group work, the instructor will determine the members of each group. This approach should effectively deter any student from not being chosen to join a group, which would be detrimental to that student’s group experience. Another way to assure a positive and productive experience is to deliberately make clear to the class how the groups will operate and how students will be graded, provide explanation of the objectives of the group work and define any relevant concepts (Gross-Davis, 1993). Teaching and Learning Evaluation Tools Evaluation tools have been developed by the instructor in order to allow the instructor to appraise the learning objectives. “The advantage of internally developed evaluations is that they can be customized to the program” (Billings & Hallstead, 2005, p. 563). As DeYoung (2003) states, “Evaluation methods should be based on learning objectives. Objectives might be evaluated by giving a test of some sort, a behavioral evaluation, or a graded assignment” (p.264).

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Faculty need numerous evaluation methods to properly document and demonstrate their teaching effectiveness (Billings & Hallstead, 2005). One evaluation method to be used here is the behavioral evaluation, which takes the form of the IV insertion check-off list. The evaluation tools are meant to provide the instructor with useful feedback in the current and future design/implementation of his or her course. A formal checklist evaluation tool for the student’s return demonstration will be provided at the end of this paper (see Appendix A). The checklist evaluation tool will be used by the instructor evaluating the student nurse’s performance. In order to be considered competent in IV insertion, the student nurse must achieve a 90% accuracy rate when completing the checklist. A Likert scale evaluation tool has been devised to evaluate the student’s perception of learning in regard to IV insertion (see Appendix B). A second Likert scale evaluation instrument has been developed to gain the student’s perception of the teacher’s effectiveness for this learning module (see Appendix C). When we want to know the feelings, and attitudes of our respondent’s we should consider using Likert scale questions (Waddington, 2000). Conclusion So, in conclusion, the teaching strategies to be used during the class session on IV insertion were discussed. It was found that the lecture-discussion method is an appropriate teaching method to use, especially when combined with other forms of instructional strategy. We examined the necessary resources for implementation of the teaching plan. These resources include students, personal computers, use of the nursing skills laboratory, needed supplies for IV insertion, and mannequins. Multiple approaches for assuring a positive and productive experience were considered. The importance of evaluation tools is considered, and the instructor has developed his own instruments which are available for viewing in the appendices following the text.

References: Billings, D., & Halstead, J. (2005). Teaching in nursing a guide for faculty. (2nd ed.). St. Louis, MO: Elsevier Saunders. Bradshaw, M., Lowenstein, A. (2007). Innovative teaching strategies in nursing and related health professions. (4th ed.). Sudbury, MA: Jones and Bartlett Publishers. Cuyamaca College. (2003). Visual learning [Fact sheet]. Retrieved from http://www.cuyamaca.edu/eops/dsps/resourcesvis.asp Daniel, E. (1999). INLS 214: user education--notes lecture-discussion method [Fact sheet]. Retrieve from http://ils.unc.edu/daniel/214/lecture.html#schema DeYoung, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, NJ: Pearson Education, Inc. Gross-Davis, B. (1993). Collaborative learning: group work and study teams. Tools for teaching. Retrieved from http://teaching.berkeley.edu/bgd/collaborative.html Perry, A. & Potter, P. (1994). Clinical nursing skills & techniques. (3rd ed.). St. Louis, MO: Mosby-Year Book, Inc. Stokes, S. (n.d.). Visual literacy in teaching and learning: a literature perspective. Electronic Journal for the Integration of Technology in Education, 1(1), 10-18. Retrieved from http://ejite.isu.edu/Volume1No1/pdfs/stokes.pdf Waddington, H. (2000). Types of survey questions. Encyclopedia of Educational Technology. Retrieved March 15, 2008, from http://coe.sdsu.edu/eet/Articles/surveyquest/start.htm

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Appendix A Check-off Competency: IV Insertion Instructions: This tool is used both to help prepare the student for the final competency evaluation and to help the instructor fairly, accurately, and consistently rate each student’s performance. The student must perform an IV insertion for use as a SL, from start to finish achieving 90% accuracy on the check-off competency in order to be considered competent in IV insertion. 

Gather and organize equipment.

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Wash hands.

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Open sterile packages using aseptic technique.

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Select the appropriate IV insertion device.

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Select the most distal site for peripheral start.

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Place the extremity in a dependent position if possible.

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Initiate tourniquet 5-6 inches above the intended insertion site.

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Check for presence of distal pulse.

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Don gloves.

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Select the appropriate site in a well-dilated vein.

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Cleanse the insertion site with alcohol prep.

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Anchor the vein by placing thumb on the vein and stretching the skin against the direction of the insertion. (do this approx. 2-3 inches distal to the site)

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Insert the IV cannulazation device with the bevel up at an approximate 20-30 degree angle in the direction of the vein.

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Look for blood return through the flashback chamber of the device.

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Lower the needle until the hub rests upon the venipuncture site.

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Advance the catheter about ¼ inch into the vein and then loosen the stylet.

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Advance the catheter into the vein until the hub rests at the venipuncture site (Do not reinsert the stylet once it has been loosened).

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Stabilizing the catheter with one hand, remove the tourniquet with the other, and remove the stylet.

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Quickly attach needle adapter of the SL to the hub of the catheter.

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Secure IV catheter: a) place narrow strip of tape beneath the hub of the catheter sticky-side up and criss-cross the tape over the catheter b) place second narrow strip of tape directly across the hub of the catheter c) place 2x2 gauze pad over the insertion site and cover with a transparent dressing.

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Flush SL with 1-3 milliliters (ML) of sterile saline for infusion.

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Communicate date, time, gauge of catheter, and nurse’s initials on the dressing.

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Doff gloves, discard trash, and wash hands.

Tool is adapted from procedure outlined in Perry & Potter (1994).

Appendix B Student Evaluation of Learning: IV Insertion Directions: On a scale of 1 to 10, rate each of the following statements based upon your level of agreement. On this scale, 1 represents extreme disagreement, 3 represents disagreement, 5 is neither agree nor disagree, 7 represents agreement, and 10 represents extreme agreement. One must not limit responses to these numbers listed; this is meant to provide understanding of the rating system. Circle the appropriate choices and turn in before leaving the class. There is no need to include your name on this form.

1. I feel that learning objectives were achieved………………………………1 2 3 4 5 6 7 8 9 10 2. I feel that the group component of this learning module enhanced the overall learning experience……………………………………………………………………..1 2 3 4 5 6 7 8 9 10 3. I feel that the knowledge gained from lecture assisted me in the laboratory setting while performing hands-on actions…………………………………………………..1 2 3 4 5 6 7 8 9 10 4. I feel that the required readings and additional personal research enhanced my understanding of the subject matter……………………………………………………………1 2 3 4 5 6 7 8 9 10 5. I now feel competent (in the laboratory setting) in starting IV lines………..1 2 3 4 5 6 7 8 9 10

In this section, please provide written feedback of your learning experience.

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Appendix C Student Evaluation of Teaching Methods Directions: On a scale of 1 to 10, rate each of the following statements based upon your level of agreement. On this scale, 1 represents extreme disagreement, 3 represents disagreement, 5 is neither agree nor disagree, 7 represents agreement, and 10 represents extreme agreement. One must not limit responses to these numbers listed; this is meant to provide understanding of the rating system. Circle the appropriate choices and turn in before leaving the class. There is no need to include your name on this form. 1. Reading Assignments/independent research was useful in gaining knowledge prior to the lecture-discussion………………………………………………………………1 2 3 4 5 6 7 8 9 10 2. I feel the lecture-discussion is necessary for beginning to learn about IV insertion………………………………………………………………………...1 2 3 4 5 6 7 8 9 10 3. The instructor gained my attention and maintained my attention throughout the course of the lecture-discussion………………………………………………………………1 2 3 4 5 6 7 8 9 10 4. The initial presentation of an IV insertion by the instructor was valuable to me………………………………………………………………………………1 2 3 4 5 6 7 8 9 10 5. Small group work was appropriate for the hands-on practice session in the skills lab………………………………………………………………………………1 2 3 4 5 6 7 8 9 10 6. The instructor allowed adequate time for preparation of IV insertion skills prior to the final check-off procedure……………………………………………………………1 2 3 4 5 6 7 8 9 10 7. The instructor provided for varied learning opportunities………………….1 2 3 4 5 6 7 8 9 10 8. Please use the space provided below to answer or attach a separate page…Are there any suggestions/concerns you have that would help the instructor improve his effectiveness?

9. Please make any additional constructive comments about the class/teaching methods here.