Self-Directed Versus Traditional Clinical Learning Model on Nurses' Airway Management Competencies

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Effect of Self-Directed Versus Traditional Clinical Learning Model on Nurses' Airway Management Competencies and Patients' Airway Related Incidents Introduction Airway crisis situations in ICUs (Intensive Care Units) are common, complex, dynamic and time-sensitive contexts, that pose a significant threat to patient safety, and are a major source of preventable errors. Airway management has the highest priority in patient care, it is the first step in the (ABCDE) approach. The concept of Airway management in nursing perspective includes any nursing procedures and techniques required to keep the airway open and prevent aspiration. Adult learning is a practice in which adults engage in systematic and sustained learning activities in order to gain new forms of knowledge, skills or values. Most adult education is voluntary; therefore, the participants are generally self-motivated. Continuing education (CE) of nurses is increasingly necessary to keep abreast of rapid changes in patient care due to advancements in knowledge and technology and improve their ability to serve the patients safely. Although nursing care has been changed significantly over the past 30 years, methods for clinical training nurses have not. A popular or traditional model for clinical teaching of nurses, including but not limited to; integrating lectures, skills laboratory training and supervised clinical experience. A benefit of this model is the opportunity to assist nurses to integrate the concept learned in class or skill lab in patient care. Also, the instructor can select clinical activities that best meet nurses' needs and are consistent with hospital goals. While, Self-directed learning (SDL) is one of modern approaches of clinical learning, the concept of SDL originates from the Adult Learning Theory, it is a process in which the instructors play a facilitating role while, learners actively participate in identifying their own learning needs, learning goals, allocating resources \& decide whether learning method can be used, and engaging in self-reflection \& evaluation. The positive outcomes of SDL including but not limited to, greater self-control, self-confidence, autonomy, and lifelong learning skills. In essence the aim of this study will be examining the effect of Self-directed clinical learning model as compared to the traditional models to improve nurses' Airway management competencies and minimize airway related incidents. Research Hypothesis H1: Critically care nurses who will approach self-directed clinical learning model (μ1) will have a higher level of Airway management skills (μ2), (H1: μ1 \> μ2). H1: Intensive care units who will approach self-directed clinical learning model to learn their working nurses (μ1) will have a lower frequency of patients' airway-related incidents (μ2), (H1: μ1 \< μ2). Subjects and Methods True experimental, prospective, and comparative research design will be utilized in the current study. This study will be conducted at selected two Adult Intensive Care Units, A convenience sample of 60 male and female Critically Care Nurses who are working in the selected Intensive Care Unit, will be recruited to the study. The sample size estimated by (G Power analysis) (independent t tests - One tail, Effect size = 0.65, α = 0.05, Power (1-β) = 0.80, balanced allocation ratio 1:1). The total sample size will be divided into two groups (study and control). All nurses should be corresponded to specific inclusion criteria. Five tools will be formulated to collect data pertinent to the study. Procedure The study will be conducted through three phases; preparation \& designation, implementation, and follow up \& evaluation phase. The 1st Part will be initiated by allocating the selected ICUs randomly into two paired settings, one for applying traditional learning (control ICU) and the other for self-directed learning experimentation (study ICU). the nurses who are working in selected ICUs and correspond to the inclusion criteria, will be randomly distributed into two equal groups (30 nurses in each group). The nurses who are working in study ICU will be asked to fill out the nurses' readiness assessment sheet to learn independently. The nurses who will demonstrate a high readiness score (\>80%) for independent learning will be included. Once implantation is complete, the follow-up and evaluation phase will be initiated by daily monitoring of the occurrence of patients' airway related incidents in both control and study ICUs for a continuous three months. Then, the nurses' knowledge and practices (in the control group) will be evaluated two times, 1st time will be 1 month after the implementation phase, and the second time will be after 3 months from the 1st evaluation (to measure the retention of given education and training). Upon completion of data collection, descriptive and inferential statistics will be utilized to test for differences among the study and control group subjects.

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