Teaching Experience

1. Teaching Experience Bobbie Hudson, BSN FNP student Sonoma State University

2. Demographics & Environment • 10 Semester II Nursing students from CSU, Chico. • Post clinical conference at Oroville Hospital conference room with projector capabilities. • Basic ABG interpretation with review of acid/base balance physiology. • Mentor: Regina Ottem, APN

3. Knowledge & Qualifications • Bobbie Hudson, RN,BSN, MSN/FNP -S • 10 years acute care experience as an RN including ER, ICU, telemetry, pediatrics, PACU, OR, ambulatory care, oncology. • Experience in precepting nursing students and new nursing graduates for 8 years. • Charge nurse experience.

4. Preparation to teach • Review of N510 course and objectives for teaching project. • Review of CSU, Chico mission statement, framework, and philosophy. • Review of literature and research relevant to topic. • Assessment of knowledge base and deficits of students in subject area gathered through information provided by nursing instructor. • Review of existing clinical guidelines and laboratory references for ABG interpretation. • Prepared handout material including critical thinking exercises, and laminated pocket guide.

5. Organization Framework, Mission, and Philosophy • CSU, Chico Organizing Framework “The organizing framework of the School of Nursing is composed of four major concepts of the metaparadigm of the profession of nursing. These are person, health, environment, and nursing. The curriculum is designed to reflect the relationships among and between the elements.” (CSU, Chico website, 2011) • CSU, Chico Mission “…the school provides high quality, student-centered learning environments that utilize technological innovation and promote critical thinking.” (CSU, Chico website, 2011) • CSU, Chico Philosophy “The philosophy for the CSU, Chico School of Nursing identifies the underlying beliefs and values regarding how this mission can be met, describing beliefs about the components of nursing's meta-paradigm: persons, health, nursing, environment, and nursing education.” (CSU, Chico website, 2011)

6. Nursing Theory • In keeping with CSU, Chico school of nursing framework, mission, and philosophy I found Barbara M. Artinian: The Intersystem Model to be the theory most applicable in preparing my teaching session because the model incorporates the concepts of person, environment, health, and nursing action. • Under this theory person can be individualized to mean the patient or it can be used to describe a group such as semester II nursing students in this clinical session. • Environment can be internal, external, developmental, or situational. • Health is viewed on a continuum of health and disease. • Nursing action “is identified by the mutual communication, negotiation, organization, and priorities of both the client and nurse intrasystems” (McEwen & Willis, 2007)

7. Nursing Theory • The Intersystem model can be applied in both clinical practice and education. • In clinical practice the person is the patient, in education the person is the collective nursing students. • In clinical practice the environment is related to the patient, in education it is related to the situation. • In clinical practice health can be defined for the client on the continuum of health and disease, and in education it can be referred to as the state of functioning of the nursing group. • In clinical practice nursing action involves the nursing students’ ability to identify problems and potential problems, communicate these, and prioritize their nursing interventions.

8. Course Description • The course is designed to teach the basics of mechanisms that control acid base balance in the body, the method used to evaluate that balance (arterial blood gas), and the systematic steps used in interpreting that method. The students are provided with several outlines: 1. mechanisms that control acid base balance in the body. 2. Case studies that cover various acid base imbalances. 3. Written test with sample ABG results for students to interpret. 4. A laminated pocket guide for future reference.

9. Course Objectives • Review of physiology related to acid base balance. • Learn to interpret ABG values and identify underlying pathology. • Define the relationship between the patient, their state of health, the hospital environment, the role of nursing, and the utilization of the nursing process in caring for the patient with acid base imbalances. • Promote critical thinking of nursing students when interpreting ABG’s and the implications of the results for both the patient and the nursing care plan. • Identify the role of the nurse in caring for the patient with acid/base imbalances.

10. Handout Outline • The teaching session began with a handout of the mechanisms which control acid base balance. This provided the students with basic review of background information. This handout was discussed and questions were addressed. • A handout was given that provided the students with normal ABG reference ranges and the four step process involved in ABG interpretation. • Students were given a laminated pocket card with the normal values and the four step process for interpretation of ABG’s.

11. Handout Example ABG Interpetation The four steps to interpretation: The Basics: 1. Is the ABG normal? If so stop, if not go to #2 There are 3 ABG values: 2. Is the pH acidotic or alkalotic? pH (acid base balance) -acidotic: if pH is <7.35 CO2 (carbon dioxide) -alkalotic: if pH is>7.45 HCO3 (bicarbonate) 3. Is the cause respiratory or metabolic? Normal ABG values: -Metabolic Acidosis: if the pH is acidotic and HCO3 is acidotic pH= 7.35-7.45 -Metabolic Alkalosis: if the pH is alkalotic and HCO3 is alkalotic CO2=35-45 -Respiratory Acidosis: if the pH is acidotic and CO2 is acidotic HCO3=22-26 -Respiratory Alkalosis: If the pH is alkalotic and CO2 is alkalotic Additional Infromation: 4. Is it compensated or uncompensated? CO2 >45 is acidotic -Uncompensated: if the pH is anywhere outside normal range. HCO3<22 is acidotic -Compensated: if the pH is anywhere inside the normal range. CO2<35 is alkalotic HCO3>26 is aklalotic This is the information printed on the laminated cards provided.

12. Handout Example Mechanisms that control the blood's acid-base balance Role of the Lungs: One mechanism the body uses to control blood pH involves the release of carbon dioxide from the lungs. Carbon dioxide, which is mildly acidic, is a waste product of the metabolism of oxygen (which all cells need) and, as such, is constantly produced by cells. As with all waste products, carbon dioxide gets excreted into the blood. The blood carries carbon dioxide to the lungs, where it is exhaled. As carbon dioxide accumulates in the blood, the pH of the blood decreases (acidity increases). The brain regulates the amount of carbon dioxide that is exhaled by controlling the speed and depth of breathing. The amount of carbon dioxide exhaled, and consequently the pH of the blood, increases as breathing becomes faster and deeper. By adjusting the speed and depth of breathing, the brain and lungs are able to regulate the blood pH minute by minute. Role of the Kidneys: The kidneys are also able to affect blood pH by excreting excess acids or bases. The kidneys have some ability to alter the amount of acid or base that is excreted, but because the kidneys make these adjustments more slowly than the lungs do, this compensation generally takes several days. Buffer Systems: Yet another mechanism for controlling blood pH involves the use of buffer systems, which guard against sudden shifts in acidity and alkalinity. The pH buffer systems are combinations of the body's own naturally occurring weak acids and weak bases. These weak acids and bases exist in balance under normal pH conditions. The pH buffer systems work chemically to minimize changes in the pH of a solution by adjusting the proportion of acid and base. The most important pH buffer system in the blood involves carbonic acid (a weak acid formed from the carbon dioxide dissolved in blood) and bicarbonate ions (the corresponding weak base). Acidosis and Alkalosis: The two abnormalities of acid-base balance. Acidosis and alkalosis are not diseases but rather are the result of a wide variety of disorders. The presence of acidosis or alkalosis provides an important clue to doctors that a serious problem exists. Acidosis and alkalosis are categorized as metabolic or respiratory, depending on their primary cause. Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the production of acids or bases and their excretion by the kidneys. Respiratory acidosis and respiratory alkalosis are caused primarily by changes in carbon dioxide exhalation due to lung or breathing disorders.

13. Assessment of Learning • Using their previous handouts provided the students were given a handout of test questions. The test included five sample ABG printouts which the students were to interpret as either normal, metabolic acidosis, metabolic alkalosis, respiratory acidosis, or respiratory alkalosis, and whether these conditions were compensated. • The test questions were discussed providing answers, rationale, and implications. • Open discussion session and Q&A session provided • Test questions discussed one by one.

14. Test Question Example • Case example test questions: pH 7.23, CO2 50, HCO3 22 What do we have here? Is the ABG Normal? Why? Is the pH acidotic or alkalotic? Why? Is the cause metabolic or respiratory? Why? Is it compensated or uncompensated? Why? pH 7.50, CO2 18, HCO3 24 What do we have here? Is the ABG normal? Why? Is the pH acidotic or alkalotic? Why? Is the cause metabolic or respiratory? Why? Is it compensated or uncompensated? Why?

15. Student Evaluation Student Evaluation of Teaching Were the course objectives clear? Stongly disagree disagree neutral agree strongly agree Was the content of course organized? Stongly disagree disagree neutral agree strongly agree Was the content informative? Stongly disagree disagree neutral agree strongly agree Was the information taught applicable to the clinical setting? Stongly disagree disagree neutral agree strongly agree What did you like most about the course? What did you like least about the course? What areas could be improved? Additional comments Every student expressed that they enjoyed the case examples and found the laminated pocket reference card to be a valuable tool.

16. Mentor Evaluation • Mentor filled out the same evaluation as students. • My mentor gave me immediate feedback that included: -kept the content level appropriate. -content was informative but not overwhelming for the class level of education. -provided excellent handouts. -very calm, nice teaching style, very personable. -I will use the handouts for future classes.

17. Self Evaluation • I caught an error that I had made in reference ranges which the class also caught and many mentioned it on their evaluation as an improvement that could be made. I have to be more careful when editing my work as an error can prove very confusing and cause fragmentation of information. • Through discussion I found myself off topic and had to pull myself back and find where I was. • Overall this was an educational experience and I had a lot of fun with it.

18. References McEwen, M. & Willis,E.M. (2007). Theoretical Basis for Nursing (2cd Ed.).Philidelphia: Lippincott Williams & Wilkings