MSN 202 COURSEWORK

In Partial Fulfillment of the Requirements for the course

CLINICAL REASONING AND TEACHING

for the degree Master of Science in Nursing – Adult Health

Submitted by:
Princess Ann Y. Gonzalez, RN
Franz S. Garcia, RN
Gracie Allaine S. Sugatan, RN

SPUP MSN 2019 Students

Submitted to:
Maria Girlie Jordan, MSN
SPUP Graduate School Faculty

3rd Trimester 2019-20

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 TABLE OF CONTENTS

Coursework #1 EVIDENCE BASED PRACTICE PROPOSAL

(Effectiveness of the Intravenous Pre-filled Syringe Flushing Kit for Adult
Patients in the Emergency Department) ……………………………… 2

Coursework #2 TEACHING PLAN (1)

(Developing and Providing Students with Activities to develop Skills, Knowledge
and Appropriate Attitude and Values on the Health Promotion) ………. 12

Coursework #2 TEACHING PLAN (2)

(Management of Health with Acute Health Alterations) ……………….. 17

Coursework #3 INDIVIDUAL ACTIVITY: MY TEACHING PHILOSOPHY

1. Princess Ann Y. Gonzalez, RN …………………………………... 8
2. Franz S. Garcia, RN ……………………………………………… 9
3. Gracie Allaine S. Sugatan, RN …………………………………… 10

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 COURSEWORK #1
EVIDENCE BASED PRACTICE
PROPOSAL

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 EFFECTIVENESS OF THE INTRAVENOUS PRE-FILLED SYRINGE FLUSHING KIT
FOR ADULT PATIENTS IN THE EMERGENCY DEPARTMENT

P - Adult Patients in the Emergency Department

I - Use of Intravenous Pre-Filled Syringe Flushing Kit
C - Versus manual preparation of saline syringes
O - Prevention of Complications, Time involved in manual preparation of saline
syringes

CLINICAL QUESTION

How fast and effective is the IV medication flushing kit used for adult patients in the
Emergency Department compared to manual preparation of saline syringes?

REVIEW OF RELATED LITERATURE

IV stands for “intravenous” or “inside the vein”. It means that the patient receives
substances directly to their veins through a tube called a cannula. This could be either
medication or nutrition. IV Therapy is a common practice for administering fluids to
dehydrated patients, medications, chemotherapy treatments, and blood transfusions.

Peripheral intravenous catheters (PIVC) are the most commonly used intravenous
device in hospitalised patients. They are primarily used for therapeutic purposes such as
administration of medications, fluids and/or blood products as well as blood sampling. Yet
failure prior to completion of therapy occurs in up to 69 % of patients. This may be due to a
range of complications, which can be mechanical, vascular or infectious. Mechanical
complications include occlusion, infiltration and dislodgement. Vascular complications
include venous thrombotic occlusion and phlebitis (irritation or inflammation of the vessel
wall). Infectious complications may be bacterial or fungal, and local or systemic bloodstream
infections. Complications lead to device failure and device replacement, which results in
interrupted therapy, pain associated with resiting and increased health care costs for
resources and staff time. Bloodstream infections prolonged hospitalisation and increase
treatment costs and mortality.

The hand is a common site for minor and major IV catheter complications. Women
and older patients are more susceptible to these complications. Peripheral IV line
complications are not uncommon and can result in morbidity and increased health care
costs from prolonged hospitalization, extended use of IV antibiotic therapy, and surgical
intervention.

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 Current practice recommendations are to flush PIVCs before and after each
medication administration, and at regular intervals when PIVCs are not in use. The
theoretical purpose of flushing is to maintain catheter patency by preventing internal
luminal occlusion, reducing build-up of blood and other products on the PIVC internal
surface and preventing interaction of incompatible fluids/medicines.

A saline flush is the method of clearing intravenous lines (IVs) of any medicine or
other perishable liquids to keep the lines (tubes) and entry area clean and sterile. Blood left
in the cannula or hub can lead to clots forming and blocking the cannula. Flushing is
required before a drip is connected to ensure that the IV is still patent. It is also used after
medications are delivered by the medication port to ensure all the drug is delivered fully. If
multiple medications are given through the same line, flushing can be used in between
drugs to ensure that the medicines won't react. Flushing with saline should be painless if the
cannula is in its proper place, although if the saline is not warmed there may be a cold
sensation running up the vein. A painful flush may indicate phlebitis and is an indication that
the cannula should be relocated.

Prefilled syringes of saline flush solutions save time for nurses and improve patient
safety by reducing the risks of medication errors, needle-stick injury and microbial
contamination. Moreover, because prefilled syringes are fully labelled, the risk of mis-
selection is reduced. An additional factor to take into consideration is the time saving for
nurses – the costs (including disposable items and nurse time) of ad hoc preparation of
intravenous doses are often overlooked but they can be significant in a busy ward. One
study showed the total nursing time input with prefilled syringes was 42% lower than with
conventional injection systems.

Pre-Filled Saline Syringe complies with major PICC manufacturer recommendations

for flushing with a 10-mL diameter syringe. It also improves clinician efficiency and workflow
by eliminating the steps and time involved in the manual preparation of saline syringes.

STATEMENT OF THE PROBLEM

Intravenous Pre-filled Syringe flushing kit is faster and more effective in decreasing
intravenous complications to the adult patients in the emergency department.

RECOMMENDATION

In Northampton General Hospital, a key recommendation was that all syringes and
infusions containing injectable medicines that leave the hands of practitioners during use
should be labelled. Discussions with ward and theatre staff suggested that this would be
difficult to achieve in practice for flushing solutions because of the numbers involved.
However, the safety principle was understood and all staff were keen to find a solution.
Prefilled, ready-to-use syringes containing 0.9% sodium chloride injection were the ideal
solution to this problem. The key advantages are that they are clearly labelled and because
they do not require additional manipulation the risk of microbial contamination is

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minimised. Furthermore, the risk of needle-stick injuries is reduced because no ‘drawing up’
is required. The hospital now uses needle-free systems wherever possible.

This initiative provided the opportunity to examine critically the use of saline and
heparin flushes in the hospital and to draft guidance on best practice. We identified all the
types of vascular access devices that were in use in the hospital and, in discussion with
clinicians in the relevant directorates we agreed on the appropriate flushing procedures. In
line with the National Patient Safety Agency guidance, saline flushes are recommended for
all peripheral lines and heparin flushes are used for some arterial lines and central venous
catheters according to local policy.

They chose the 3ml prefilled saline syringes because this was the volume most
suitable for flushing peripheral lines. The paediatric department initially had concerns about
the possibility of high pressures being generated in the flushing syringe and the potential for
catheter damage as a result. However, the PosiFlush prefilled syringes that we selected have
the same diameter as a standard 10ml syringe and generate significantly lower pressures
than smaller diameter syringes and are therefore safe for paediatric use.

The prefilled saline syringes were introduced throughout the hospital using a poster
campaign, to ensure that only saline flushes were used to flush peripheral lines, and in-
service training in the use of the prefilled syringes. One big advantage of having trainers visit
the wards was that they were able to reinforce the key messages in the NPSA guidance and
emphasise the importance of labelling of injectable products.

Although no formal evaluation has been undertaken there is general agreement that
the flushes have been an immensely helpful addition to the trust. Both doctors and nurses
value them as they support safer administration of injectable medicines – they are easy to
use and reduce the work burden involved in preparing flushes at the bedside.

BD PosiFlush has been well received by all staff and the introduction of the pre-filled
flushes across the trust has been supported by Safer Patients In Northamptonshire (SPIN) –
a group of doctors, nurses, healthcare professionals, managers, patient representatives and
board members that works together to put patient safety first. SPIN recognised that BD
PosiFlush could reduce the risk of infection to the patient by reducing the number of
manipulations required to prepare them for treatment.

IMPLEMENTATION AND METHODS

This study will be carried out in the Emergency Department of St. Luke’s Medical
Center - Global City. 10 staff nurses will be participating in the study comparing the time and
practice of preparing and administering manually prepared saline syringes versus pre-filled
saline syringes Kit. Written consent will be obtained by the participants. The observational
session will last for 2 hours. In the 1st hour, staff nurses will carry out the standard practice
of preparing the manual syringe flushes. After the observation of the nurses, they will be
given a brief orientation on how to use the prepared pre-filled saline syringes or what we
call the “IV Medication Kit”. The flushing kit consists of clean gloves, alcohol swab, 5ml
posiflush and 10 ml posiflush. Following the sandwich method, before giving the medication,

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5ml will be flushed first following the medication and 10ml flushing after. Data that will be
collected will include the individual task time, equipment used, adherence to the principles
of aseptic non-touch technique, compliance in the protocol of flushing and effects of the
both preparation in decreasing complications. SPSS will be used for statistical analysis.

REFERENCES:
Hadaway LJ Infus Short, Peripheral Intravenous Catheters and Infections. Nurs. 2012 Jul-Aug;
35(4):230-40.

Tuffaha H, Rickard CM, Wenbster J, Scuffham P, Marsh N, Gordon L. Cost Effectiveness

Analysis of Clinically Indicated Versus Routine Replacement Of Peripheral Intravenous
catheters. Appl Health Economics Health Policy. 2012;12(1):51–8. doi: 10.1007/s40258-013-
0077-2.

Maki DG, Ringer M. Risk factors for Infusion-Related Phlebitis with Small Peripheral Venous
Catheters. A Randomized Controlled Trial. Ann Intern Med. 1991;114(10):845–54. doi:
10.7326/0003-4819-114-10-845.

Malach T, Jerassy Z, Rudensky B, Schlesinger Y, Broide E, Olsha O, et al. Prospective

Surveillance of Phlebitis Associated with Peripheral Intravenous Catheters. Am J Infect
Control. 2006;34(5):308–12. doi: 10.1016/j.ajic.2005.10.002.

Kagel, Eric M. MD; Rayan, Ghazi M. MD. Intravenous Catheter Complications in the Hand
and Forearm. The Journal of Trauma: Injury, Infection, and Critical Care: January 2004 -
Volume 56 - Issue 1 - p 123-127
https://journals.lww.com/jtrauma/Abstract/2004/01000/Intravenous_Catheter_Complications_in_t
he_Hand_and.21.aspx

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 COURSEWORK #3
INDIVIDUAL ACTIVITY:
MY TEACHING PHILOSOPHY

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PRINCESS ANN Y. GONZALEZ
I believe that learning takes place best in a positive safe environment filled with
laughter. Effective learning requires a collaboration between teacher and students. Keeping
students engaged can be a difficult task for any teacher, but it becomes especially hard to
maintain engaging teaching strategies as school breaks approach or during holiday seasons.

As a teacher, you may get a group of students that you just can’t seem to keep
interested in. No matter what you do, it seems like all of the students are bored out of their
minds. If students aren’t paying attention, and their minds are wandering, then they are not
absorbing any of the information that you are giving them to pass your class. If you want
your students to be interested in what you are teaching them, you must make it interactive.
As a teacher, you can show who you are and that makes your students feel comfortable
with you. Forget the sage on the stage and engage your students in a casual conversation
like you would a good friend. When you create a real-world connection to what students are
learning, it will give them a greater understanding of why they need to learn it. In this world
today, technology is what students live and breathe every day. If you want to make your
class the most interesting class that everyone loves to go to, then you must incorporate
some kind of technology. Allowing your students creative freedom in their learning is
essential. Learning off set phrases is useful up until a point. After that, they need to be able
to understand why a particular word is said in a particular way, and how they can
manipulate it to suit the current situations.

Overall, talk less and involve students more. The more you make your class
interactive and the more that you utilize technology, the more your students will enjoy what
they are learning.

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FRANZ S. GARCIA
Teaching and learning are closely interconnected in many ways. A person learns
when another person teaches them. The extent to which people learn, though, depends on
the quality of the teaching. A good teacher is someone who takes the time to get to know
their specific students and their needs and how they learn. In this way, the amount the
students learn can be maximized. In this sense, a teacher is also always learning while
teaching, as a teacher must learn how to reach their students most effectively. A person can
also learn something by teaching it. By teaching something to others, a person verifies that
they understand the material very deeply. Only when someone understands a subject or
material at this deep level are, they able teach it to others. Therefore, teaching and learning
are closely connected.

Life is the best teacher, your experiences in life matters a lot in learning. Experiences
teaches you about the real things in life. You can learn few things when you read about
things. However, the true form of education comes with the real-life experience. Then
experience teaches us the real-life lessons. You can’t grow as a person without making few
mistakes. So, it is important to learn from what you have seen in life and use that as a tool
for personal growth. Remember that you can’t achieve personal growth in life without
experience. Life is nothing but just a series of learning opportunities and experience. It is not
possible that a person knows all about life at a very young stage. That is why over the time
we all learn of thing that we need and it is known as experience. It is also important to
remember that experience can also be good or bad, however, both kinds of experiences are
required in life to make sure that you succeed in life and do well. In many ways for me, life
experiences is actually the best way in learning.

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SUGATAN, GRACIE ALLAINE S.

According to Cambridge English Dictionary, Philosophy is the use of reason in

understanding such things as the nature of the real world and existence, the use and limits
of knowledge, and the principles of moral judgement. As a Christian, God has given me the
Holy Spirit to help me in this journey. God, as my authority, imparts wisdom and knowledge
to me so that I, in turn, can impart wisdom and knowledge to my students. And through this
personal Philosophy of Education of mine, I will be able to share my thoughts and actions on
a Christian perspective.

A. ROLE OF EDUCATOR

It is a vital role being a Christian Educator. One being a Christian, he has experienced
the reality of God's truth, and he has God's Spirit to empower him and his teaching. As an
Educator he functions in accordance with the mandate of God to teach in accord with the
educational principles contained in the Word of God. Educate means to change one's
behavior. The Bible site an example on how the leaders should set an example to their
followers. This must be true for the teachers too, as a teacher, we should be an example on
the things that we are trying to teach. Each teacher is different from the other. They have
their unique way on how they will relate to their students. But I believe that a Christian
Educator should be the one who can communicate the truth. Who can clearly make a stand
for what is right from wrong. The one who knows the Word of God and living for it. The one
who is committed in every aspect of his/her life. A teacher who always strives for excellence
for the glory of God. And of course, a teacher must truly love his/her students, seeking their
highest good even when at times the way may be hard. Not only should he/she love his
students, he/she should genuinely like and understand them.

B. ROLE OF LEARNER

As we all know, each learner differs from each other. As a teacher, we should be able
to know them personally. Which makes the learner as one of the challenges in teaching
realm. Some of the learner comes to class with the purpose of learning but most of them
comes to class bringing their set of personal needs, wants and goals. Each is looking for
fulfillment and growth in his own personal and spiritual life. Every learner starts with his
own basic needs, thus the educator must seek to motivate the learner to discover and apply

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God's provisions to his life. In Christian education true learning comes as the learner
experiences the wonder of God's truth applied to his life.
Each learner is special. As we are all special in God’s eyes. All of their personal
experiences contributes to the teaching - learning process. Some of the learners didn’t know
that as a teacher, we also learn from them. They help us to be at our best in all times. We
became motivated and driven because of them. Their role is to bring out the best in us,
teachers. So that in return, they would be able to know and understand the things that we
are trying to impart to them.

C. CURRICULUM

Upon knowing the purpose and importance of the curriculum, it came to my senses
how effective I can be if I only learn to value the curriculum that we have right now.
Curriculum as we all know serves as a guide in our teaching process. It is set on us to not
loose on tract through the whole year of teaching. But for me, it is not just a set of
guidelines or a requirement that we need to follow. It is more than that. Only if we could
see the bigger picture ahead of us. It serves as a path that tells us where we are heading in
this lifetime.
Curriculum could be one of the key for us to become an efficient educator by teaching us to
set goals for our everyday teaching. Also, it motivates us to become better and to bring the
best out of us in every aspect of teaching-learning process. Not only as a teacher to our
students, but also curriculum would help us improve personally. It reflects our personality
and how Christ is seen in our lives.

D. TEACHING METHODS

Teaching methods are strategies that would help the teacher determine on how
he/she will be able to communicate the lesson on a nature that the learners would
understand. Jesus Christ is the best example on how a best teacher must be. In the Bible,
there were lots of accounts on where Jesus Christ displays his teaching strategies. And it is
important for us to know them by heart. For we are to relay them the lesson the best way
they could understand. We as teachers, would serve as a bridge for a successful delivery of
the lesson. Just what a Philosopher once said, “The mediocre teacher tells. The good teacher
explains. The superior teacher demonstrates. The great teacher inspires.” Let us be that
great teacher who not only tells, explains, and demonstrates but rather inspires his/her
learners. Just like what Jesus Christ did who brings change to the lives of His students.

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