Using your course materials and the internet, research a speech that you feel is particularly effective, then analyze each speaker’s style and language strategies.

Using your course materials and the internet, research a speech that you feel is particularly effective, then analyze each speaker’s style and language strategies.

Research a speech.

Using your course materials and the internet, research a speech that you feel is particularly effective, then analyze each speaker’s style and language strategies.

Answer the questions.

• Who was the speaker, and what was that speaker’s main topic?
• What CORE style(s) does the speaker use in his or her speech? Cite the choice of word phrases and other clues from the speech to justify your answer.
• What you believe is the speech’s specific purpose?
• What strategies did the speaker use to achieve the specific purpose of the speech?
• Do you believe the speaker was successful in achieving the specific purpose of the speech?
• How does style and word choice in this speech impact the effectiveness of the message?
• How can you incorporate some of these techniques into your own speeches?

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

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I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Applying The Tripartite Model

Applying The Tripartite Model

Create a short (approximately two pages) plan reflecting on how the three aspects of the tripartite model of teaching, service, and scholarship could be met for a particular nurse educator position in a context of interest to you.

In your plan, please do the following:

• Describe the nurse educator role that your plan addresses, as well as any other pertinent details about that role. Be sure to give the role’s title and explain the context in which that role works.
• Analyze the teaching, service, and scholarship expectations for that role as you understand them, and how those expectations fit with the role.
• Identify publications, journals, and conferences that could be a fit for the scholarship conducted in this role. Explain the kinds of scholarship that would be a good fit for person in this role and with this expertise.
• Generate a plan that could be used by a person in this role for meeting each of the expectations you analyzed.
• Analyze additional qualifications that you believe are needed for this role (additional education, certifications, skills, and so on), explaining why they are necessary.
• Analyze the qualifications and areas of expertise related to this role that would facilitate serving as a change agent.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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1

 

Chapter 1: Introduction

Introduction

Hemorrhage is a paramount issue that can precipitate a fatal patient outcome. Massive

transfusion is a vital, high-risk treatment for extreme blood loss. The replacement of a

patient’s blood volume by rapidly transfusing blood products is particularly unpredictable.

There can be various precipitating events causing massive bleeding, all of which require quick

recognition, expeditious response, and concise treatment. Blood management and resuscitation

during hemorrhage requires a team of knowledgeable participants, with assigned roles, the

proper equipment for rapid administration and an atmosphere with structure and order (Milligan,

Higginson, & Smith, 2011).

Each massive transfusion is different, which creates a certain level of stress and

uncertainty among responding staff. When staff is inexperienced with massive transfusion

protocols or unfamiliar with the requirements, their performance can fluctuate. Performance

could be stronger under a moderate amount of stress, or they could shut down and question their

abilities. Massive transfusions require team participation, protocols, and an algorithm to follow,

in addition to hands-on training, which can ease the fight-or-flight response, support confidence

and improve patient outcomes (Stout, 2013).

Background

The use of evidence-based protocols implemented by an experienced team reduces

variability, enhances correct blood administration, and improves outcomes. The initial

demonstration of these benefits was clearly showcased by the armed services in the early 1900s

(Roberts, Chandler, & Mayles, n.d.). Their precise management of hemorrhage using a massive

bleeding protocol led to improved survivability of severe trauma in the field (Roberts, Chandler,

& Mayles, n.d.). Hemorrhage and death are familiar outcomes on the battlefield. However,

proactive care and early blood administration have prevented some deaths that were previously

seen as inevitable. Today, hospitals around the world have adopted massive transfusion protocols

based on previous, documented evidence and tracking of the military protocols and outcomes

(Roberts et al., n.d.).

Having protocols for patients undergoing massive bleeding can reduce mortality,

increase teamwork and facilitate proper product usage (Engelbrecht et al., 2013). Massive

transfusion protocols continue to evolve. Research shows the composition of protocols, massive

transfusion delivery methods, and product ratios differ by the institution (Etchill, Sperry,

Zuckerbraun, Alrcon, Brown, Schuster, Kaplan, Piper, Peitzman & Neal, 2016). In addition, the

authors noted variability in products dispensed. In some protocols, there are no plasma or

platelets dispensed during the first response, no crystalloid administration guidelines, and

calcium is not part of the protocol. Although institutions have a massive bleeding protocol, it

may need to be updated to include recent developments (Etchill et al., 2016).

The four goals during hemorrhage are; early hemostasis, restoration of oxygen-carrying

capacity, prevention of coagulopathy, and identification and treatment of the injury. With

various causes of hemorrhage, we can use massive hemorrhage clinical guidelines to determine

proper indication, correct dosing and precise timing for this high-risk procedure. The four goals

of hemorrhage, cannot be reached without collaboration and involvement of a designated rapid

response team, trained specifically in massive blood replacement. The influence of a designated,

trained team could be an advantage for early interventions and the resuscitation of the patient

(Treml, Gorlin, Dutton, & Scavone, 2017).

This Capstone project will evaluate a group of registered nurses and their response

during a simulated massive transfusion. The group will use the WellSpan York Hospital

Massive Transfusion Protocol (MTP) Algorithm (Appendix A). This protocol was developed by

Dr. Michelle Erickson in 2010 and updated in 2016 after newly published data. Dr. Erickson

updated the component algorithm and order in which products were transfused. In addition, a

Transfusion Safety Officer position was added to improve staff education with blood

transfusions. However, with each massive transfusion activation, errors continue to occur.

Some of the inaccuracy is due to a lack of communication, knowledge deficits, improper

equipment, nursing shortages and lack of bedside assistance for medication administration,

laboratory monitoring, and recording. The need to educate and train a team solely responsible for the massive response team is imperative.

During a crisis, such as massive hemorrhage, mistakes happen. Miscommunication, lack

of knowledge and uncertainty of how to properly institute a massive transfusion are areas for

improvement, and a partnership with clinicians is essential. Research proves the Crew Resource

Management (CRM) training model improves team dynamics and decreases errors (Hughes,

Benenson, Krichten, Clancy, Ryan & Hammond, 2014). This training model was originally used

in the field of aviation to improve safety. However, hospitals have tailored this model to be

used in critical situations and areas of high stress. CRM is currently taught to the trauma

and code response teams at WellSpan York Hospital. Following training, there is evidence of

better communication, knowledge of role assignment and improved relations between team

members (Hughes et al., 2014). CRM training has proven to provide safer patient care and

favorable patient outcomes (Hughes et al., 2014).

Statement of the Problem

Protocols are created to help guide the massive transfusion; however, providers do not

always follow the guidelines (Bawazeer, Ahmed, Izadi, McFarlan, Nathens, & Pavenski, 2015).

A deficiency of available resources, type of injury, delayed response of medical personnel and

understanding of proper protocol usage can have a detrimental effect on patient outcomes.

During a massive transfusion, the crisis can cause chaos and confusion. A checklist of directions

can be effective and serve as reminders of the next steps (Hilton, Daniels, Goldhaber-Fiebert,

Lipman, Carvalho, & Butwick, 2016). A massive transfusion requires close monitoring and

active management. One must monitor laboratory values, vital signs, medical intervention,

intake amounts, and blood product ratios (Pham, & Shaz, 2013).

Using a team approach to massive transfusion is essential for patient outcomes. However,

there are limited studies on a team approach to massive transfusion. Having a response team,

and a leader who is trained in transfusion medicine, treatments, coagulopathy, and interpretation

of laboratory values are necessary to improve patient outcomes (Quintana-Diaz, & Garcia Erce,

2016). Training a designated massive transfusion rapid response team, including nurses,

physicians, and other areas, such as trauma teams, anesthesia providers, and residents can

increase optimal patient care, bedside support, and expert input during the critical initiation of a

massive transfusion (Nunez, Young, Holcomb & Cotton, 2010).

Purpose

The purpose of this project is to assess the proficiency of nurses during a massive

transfusion simulation. This Capstone Project will provide essential knowledge and skills to

nurses who respond to hemorrhaging patients. Nurses require vital information such as the

WellSpan York Hospital MTP Algorithm (Appendix A), and the MTP Nursing Checklist

(Appendix B). In addition, having a list of MTP Important Phone Numbers (Appendix C) play a

key role in assembling extra resources to assist in monitoring the patient, administering blood

products, managing medications and reporting laboratory values. Having confidence in your

practice, increasing your knowledge through simulation, and working together as a team to

provide optimal care for patients can produce a feeling of empowerment. A team approach is

necessary during massive bleeding, and with the right guidance, nurses can become a

collaborative force, adding value or additional insight that may help stop the bleeding patient.

Theoretical Framework

Conceptual frameworks are theories where we assimilate, digest, and incorporate

information after being given the details. Through nursing educating, we strive to reach learning

objectives and apply that information at the bedside. Although our surroundings, beliefs, and

experience play a role in our knowledge, there are theories that support other ideas of learning.

There are six main theories of learning: behaviorism, cognitivism, social learning, social

constructivism, multiple intelligences, and brain-based learning (Rubio, n.d.).

Cognitive Learning Theory favors discovery learning. Theorist, Jerome Bruner

believed anyone could learn if it is taught to them in ways they understand. The brain-based

learning theory suggested by the theorist, John Dewey, allows learners the opportunity for batch

learning, memory recall, and intellect from repetition. In addition to these theories, humanists

believe learning is motivated by one’s inner desire to learn and should be reinforced over time

(Rubio, n.d.).

A newer instructor strategy is educating through High Fidelity Simulation (HFS), which

allows an extensive variety of experimental learning. HFS helps the learner use their mind, be

hands-on with the activity, and interact with other team members to find solutions. Each case

scenario uses the foundation of learning framework while providing educational components to

the learner (Paige & Daley, 2009).

Nature of the Project

The nature of this project is to identify knowledge deficits among nursing staff related to

the MTP. A volunteer group of registered nurses from WellSpan York Hospital will be assessed.

The project will consist of group training. The curriculum contains a short MTP Education

Module PowerPoint presentation on MTP framework (Appendix D), evidence-based practices,

blood administration order, and medications and when they are given. Additionally, nurses will

be taught the WellSpan York Hospital MTP Algorithm (Appendix A) and review Additional

Resources (Appendix E) available to them. The group will be evaluated on their understanding

of the MTP process through pre-testing, simulation, debriefing, and education.

Significance of the Project

The project can have a significant impact on patient safety, early hemostasis, and errors.

Blood transfusions are high-risk events. Having a knowledgeable, dedicated, massive

transfusion response team can decrease mistakes, increase communication, and ensure the safest

practice for every patient. The Joint Commissions (2017) established four National Safety

Goals. These goals are correct patient identification using two identifiers and improving staff

communication. Also, medication safety, and preventing mistakes, which are similar to the four

goals during hemorrhage and can be accomplished by education, training, simulation, and having

a devoted massive transfusion response team.

Definitions

Algorithm: A self-contained sequence of actions to be performed (eMedicineHealth, 2017).

Coagulopathy: A condition in which the blood’s ability to form clots is impaired (eMedicineHealth, 2017).

Crew Resource Management: A set of training procedures for use in environments where human error can have devastating effects (The Free Dictionary, 2017).

Exsanguination: Blood loss to a degree sufficient to cause death (eMedicineHealth, 2017). Topic, Nursing Research And Evidence Based Practice

Hemorrhage: To bleed profusely • Bleeding or the abnormal flow of blood (eMedicineHealth, 2017).

Hemostasis: A process which causes bleeding to stop (eMedicineHealth, 2017).

Hemovigilance: A set of surveillance procedures covering blood techniques and protocols (eMedicineHealth, 2017).

High Fidelity Simulation : An imitation of the operation of a real-world process (The Free Dictionary, 2017).

Intuitional Review Board : A committee used to approve research (eMedicineHealth, 2017).

Massive Transfusion: The replacement of >50% of total blood volume (The Free Dictionary, 2017).

Protocol: Guidelines for medical treatment (eMedicineHealth, 2017). Topic, Nursing Research And Evidence Based Practice

Summary

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Hemorrhage can cause death if not treated quickly. When an MTP is initiated, everyone

involved with the care of the patient must be prepared to act fast. Approximately 50 percent of

deaths occur within the first 24 hours’ after injury because of exsanguination and coagulopathy

(Pham & Shaz, 2013). This project is based on the belief that a committed, exclusive, massive

transfusion response team, trained and educated on the proper way to deliver blood products,

medications, and other treatments to a bleeding patient will result in positive patient outcomes

and increase patient safety. Educating a team in acceptable practice during hemorrhage must

be seriously considered. In addition, it is important to understand team dynamics, collaboration,

and communication necessary to run a massive transfusion successfully. Applying a team

approach, with assigned roles and a leader can provide the patient with optimal care during their

crisis and lead to an overall better outcome.