Running head: SHORT TITLE OF PAPER (

Running head: BRADEN RISK ASSESSMENT

Braden Risk Assessment: Education for Staff Nurses

Jessica Toner

Wilmington University

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BRADEN RISK ASSESSMENT

Braden Risk Assessment: Education for Staff Nurses

Pressure injuries are a known concern in the healthcare field within the United States

(Cooper, 2013). They are harmful to the individual, costly to the organization, and can be

responsible for someone’s death (Bergquist-Beringer, Dong, He, & Dutton, 2013). A pressure

injury is defined as “a localized injury to the skin and/ or underlying tissue, usually over a bony

prominence, as a result of pressure alone or in combination with shear” (Qaseem, Tanveer,

Starkey, Denberg, 2015, p.359).

According to Oaseem et al. (2015), pressure injuries affect an estimated 3 million

people throughout the U.S. in all settings. They go on to say that pressure injuries are responsible

for the causes of death for 115,000 people between the years 1990-2001 and an underlying cause

of death in nearly 21,000. Oaseem et al. (2015) states the estimated cost of treating a pressure

injury is often between $37,000-$70,000, as well as $11 billion spent annually in the U.S. to treat

them. There are countless products, organization, and resources available to assist with pressure

injury prevention, yet the rate of pressure injuries remains high (Bergquist- Beringer et al.,

(2013).

One pressure injury prevention-screening tool is the Braden Risk Assessment.

According to Hyan, Vermillion, Newton, Fall, Li, Kaewprag, Moffatt-Bruce, and Lenz, (2013),

this tool helps to identify those at risk for a pressure injury based on a numeric scoring system.

The tool is made up of six subscales: mobility, friction/ shear, moisture, sensory, activity, and

nutrition (Hyun et al., 2013). See Appendix 1 to view the Braden Risk Assessment Tool Each

subscale is scored on a 1-4 scale or for friction/ shear a 1-3 scale. A total score ranges from 6 to

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23 with a score of less than 18 indicating patient is at risk for obtaining a pressure injury and the

use of this tool is a generally accepted practice across United States health care settings (Hyun et

al., 2013). One barrier to pressure injury prevention is the lack of interventions put into place.

According to Bergquist- Beringer et al., (2013), “only 56.3% to 89.6% of at-risk patients

received interventions to prevent pressure ulcers recommended by clinical practice guidelines

during the 24 hour admission period” (p.411). They go on to say that patients that scored in a

mild to moderate risk for skin breakdown may be more vulnerable than their risk assessment

revealed (Bergquist- Beringer et al. (2013). Evidence shows that if there are interventions

placed, resulting from the Braden Risk Assessment, the patient is at a decreased risk of obtaining

a pressure injury (Oaseem et al., 2015).

Statement of the Problem

Pressure injuries are a known concern in the healthcare field within the United States

(Cooper, 2013). Oaseem et al. (2015) states the cost of treating a pressure injury is between

$37,000-$70,000. Also, $11 billion is spent annually in the U.S. to treat them. One pressure

injury prevention-screening tool is the Braden Risk Assessment. Evidence shows that if there

are interventions placed that were resulted of the Braden Risk Assessment, then the patient is at

a decreased risk of obtaining a pressure injury.

Purpose

The purpose of this capstone project was to reduce the incidence of pressure injuries

by assessing the understanding of staff nurses on the use of the Braden Risk assessment tool and

implementation of interventions. The goal of this capstone project was to develop, implement,

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and educate nurses regarding the use of the Braden Risk Assessment tool to help prevent

pressure injuries and increase awareness of interventions for prevention.

Significance

Implementing an educational session to staff nurses in an acute care setting on the use

of the Braden Risk Assessment Tool will help to improve patient outcomes in pressure injury

reduction (Oaseem et al., 2015). Not only is pressure injury prevention about implementing

interventions, but also about increasing nursing knowledge using evidence-based practice

(Barakat-Johnson et al., 2018). Raising awareness of prevention of pressure injuries and

treatments using a variety of approaches (education, risk assessment tool, grading scores and

clinical guidelines) can help with anticipation of an injury early in admission to a facility

(Kharabshch et al., 2014). According to Berquist-Beringer et al. (2013), a pressure injury tool

should be used to evaluate a patient’s risk upon admission to a facility as well as the initiation of:

daily skin check;

pressure-redistribution surface;

routine repositioning;

nutritional support;

moisture management (Berquist-Beringer et al. (2013).

The Centers for Medicaid and Medicare Services stated in 2008 they will no longer pay for

additional costs related to pressure injuries that are obtained in a facility (Cooper, 2013).

This means education and prevention are more important then ever in order to gain financial

freedom from the cost of paying for treatment.

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Theoretical Framework

According to Theoretical framework in research (Jacob, 2013) a theoretical framework

helps to back the hypothesis of a study with supportive articles and how it relates to the current

research. Theoretical framework helps to guide research and help the researcher determine

what’s measureable and the relationship that will be sought out.

Orem’s Self Care Theory

Orem’s Self Care Theory focuses on goals of the individual or patient maintaining

their optimal level of independence. There are three components that make up the theoretical

framework. The first component is the theory of self care, which includes the ability to care for

ones self to a certain extend depending on age, social interactions and maintain health and well

being. The second component is the theory of self-care deficit. This section is when nursing is

needed and identifies 5 theories of help: action of and doing for others, guiding others,

supporting another, providing an environment to meet future demands and teaching others. These

categories of this theory need to be handled by nurses when the individual requiring the care can

no longer make them possible. The last is the theory of nursing systems. This theory describes

how the nurse, the patient, or both needs will meet the patient’s and stating specific roles for

each individual. See Appendix 2 to view Orem’s Self-Care Theory. The theory states the reason

for the patient needing assistance and closely correlates with this capstone project. When patients

are able to care for themselves, it’s the role of the nurse to continue to encourage their

independence and find the resources to make them successful. However, such as with this

capstone project, when the patient is incapacitated and unable to complete their daily hygiene,

handle their elimination needs appropriately, and maintain a certain level of activity as well as

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getting proper nutrition. When a patient has a low Braden Risk Assessment, it’s the nurse’s role

to step in and manage and implement the necessary interventions for their risk factors (Dorothea,

2012).

Appendix 2 Orem’s Self-care Theory

Cognitive Learning Theory

The Cognitive Learning Theory focuses on learning mental and psychological

processes of the mind as opposed to behavior like other theories (Taylor & Hamby, 2013).

Cognitive theory is a type of learning theory, which is a guide for educational system planning

for general classes as well as nurses (Aliakbari, Parvin, Heidari, & Haghani, 2015). See

Appendix 3 to view Cognitive Theory. Cognitive theorists believe learning is an internal process

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that focuses on thinking, understanding, organizing, and consciousness. Students must be able to

take the knowledge they learn and incorporate problem solving, so by exploration they will be

able to actively learn, search for new information and tap into their previous experiences for new

information (Aliakbari et al., 2015). Educating nurses about the Braden Risk Assessment will

give them the ability to think about the scoring system, interpret the results and then explore the

options for intervention by using critical thinking. Being able to apply a specific treatment to

meets the individual patient needs will allow them a chance to be able to build on their already

known understanding of pressure injury prevention.

Appendix 3. Cognitive Theory

Review of Literature

A review of literatures purpose is to “provide a critical written account of the current

state of research on a selected topic” as well as gaps in past research, contribution to the

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understanding of current research, and suggestions for future research (How to write a literature

review, n.d. para 1). The literature review written below reviews article that support Education

of Braden Risk Assessment Risk Assessment using the educational process, teaching theories,

education and nursing theories, continuing education, teaching methods, and evaluation methods.

Pressure Injury Risk Factors

The author of the research article, Predictive Validity of the Braden Scale for Patients

in Intensive Care Units, Hyun et al., (2013) explore in their research if there is a valid pressure

injury risk assessment screen tool that can be used for ICU patients. The problem is, while the

Braden Risk Assessment Tool is valid, it’s uncertain to what extent it should be used for the ICU

patient. Currently the Braden Risk Assessment tool is widely used in acute care hospitals for a

pressure injury risk prevention assessment tool. The problem was identified using safety and

risk-management concerns, quality concerns, and variation in practice. The setting for this study

involved 3 adult ICUs, 39 beds each, 44 in surgical ICU beds. Braden Risks scores were

determined for all patients via electronic health records. Patients who had a pressure injury were

identified by discharge diagnosis and the data collection was approved by the IRB. A total of

7,790 ICU patients were included, with 57% male and 82% female, a mean age of 57.7 and

average length of stay was 10 days. During data collection, the research found the rate of

pressure injuries decreased due to interventions being placed. In prior studies, there seems to be

inconsistencies among the nurses in measuring the pressure ulcer risk by using the Braden Risk

Assessment scale, however, they all received preventive care. The outcomes for this study are

quantitative due to the ability to collect data from the electronic health records. Possible search

terms: Braden risk, pressure injury, ICU, and validity. Evidence used to gather data by the

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researcher from this study includes: publications, standards, and organizational data. The

researcher concludes that after reviewing four years of Electronic Health Records, the Braden

Risk Assessment scale shows little validity for use for an ICU patient with more specific

pressure injury risk factors. This article relates to the capstone project because it validates the

use of the Braden Risk Assessment Tool and the ability to identify risk factors to satisfy learning

objectives.

Pressure Injury Classification

The author of the research article, Risk Assessment and Prevention of Pressure Ulcers,

Qaseem et al., (2015) explore in their research how effective the use of risk assessment tools are

according to setting and patient characteristics and how different risk assessment tools compare

to each other. In addition, they also study what the effectiveness of relative success of

preventive injury reducing interventions and what are harms of interventions. Pressure injuries

are costly, prevalent in all healthcare facilities and are often times preventable. The current

practice is to implement strategies for pressure injury prevention. The researcher identifies the

problem from a safety and risk-management perspective, quality concerns, variations in practice

and financial concerns. The target population for these guidelines is physicians, nurses,

dietitians, and physical therapists. Data was gathered from multiple search engines throughout

the year. Other studies have suggested that prevention of hospital-acquired pressure injuries is

more effective than only providing standard care. This article shows qualitative results and low-

quality evidence that screening tools were better than clinical judgment. Direct comparisons are

limited and tools can help to identify those that are at increased risk, although sensitivities were

low. The research recommends standardizing care, simplify pressure injury interventions,

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documentation, multidisciplinary leadership and ongoing staff education. Evidence that must be

gathered by the researcher includes publications, standards, guidelines and organizational data.

Key Terms to search for include risk assessment, pressure ulcers, American College of

Physicians. This source compliments the capstone project by supporting the learning objectives:

recommending continued staff education, standardizing preventative care, using a pressure injury

prevention tool, interpreting results, and using an array of interventions for prevention and risk

factors, nutrition involvement,

Braden Risk Assessment Score/ Implementation

The article, Risk Assessment tools for the prevention of pressure ulcers, Moore, Z. E.,

and Cowman, S., (2014) explore if the use of a pressure injury risk assessment tool is helpful in

reducing pressure injuries in the healthcare setting. The research identified two research articles

that describe the effects of risk assessments on patient outcomes. After using high quality

Randomized Control Trials, it was confirmed there was no major difference between either tool,

or use of clinical judgement on it’s own. The research describes the use of the Braden Risk

Assessment tool as well as the financial burdeon of pressure injuries. The search methods for the

data for this study include several search engines. Key words to search for include Braden Risk

Assessment, pressure injuries, and prevention. The research concluded there is no advantage of

using a pressure injury prevention tool alone, but adding the nurses clinical judgement can help

to further prevent pressure injuries. This article helps to relate to the capstone project by

supporting the learning objectives for identifying the purpose of the Braden Risk Assessment

Tool, components involved in the scoring systema as well as the validity of the tool paired with

clinical judgement, and completing a Braden Risk Assessment Score using the tool.

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The research article Bergquist-Beringer, Dong, He, and Dunton (2013), explore how

one is supposed to know which pressure injury prevention program has the best outcomes. The

current practice is to implement an intervention for pressure injury prevention, but some

hospitals implement multifaceted prevention program, which has not been examined. The

problem is identified using variation in practice within the setting, current practice that has not

been validated, financial concerns, quality concerns, safety, and risk-management concerns. The

sample involved 1,419 hospitals across the U.S. and 710,626 patients had been surveyed with

data used was from the first through fourth quarter in 2010. The researcher has shown that best

practices are implemented when a patient is admitted to a facility, which includes implementing

pressure injury prevention strategies: alternative surface for weight distribution, nutrition

referral, Braden Risk assessment tool, routine repositioning, and skin assessments. Besides using

the NDNQI data collection tool, another study that is similar used a CALNOC collection tool

and found that pressure injury rates were 3.6% less equaling 1.8%. This study found that

pressure injuries were already being reduced since the data collection had begun and strategies to

continue reduction should be continued. The results are quantitative. The researcher reveals

there are still 7.9% of patients that acquired a hospital pressure injury, so continued supportive

measures are recommended for improvement. Search terms are pressure ulcer and acute care

hospital. The evidence that is gathered by the researcher includes publications, standards,

organizational data, and guidelines. This article related to the capstone project in a way that the

Braden Risk Assessment Scoring Tool can help determine a pressure injury prevention program

by validating the success of current or change in practice and supporting the learning objectives

for nutrition involvement.

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Continuing Education

The research article Duff, Gardner, and Osborne (2014), explores in their research

what the effectiveness of implementing a Respiratory Skills Update education program as well as

a program on improving nurses’ practice. The problem being addressed by the researcher is the

lack of development of an integrated educational model for continuing education framework that

result in critical thinking in the clinical environment. Currently, the researcher suggests for

changes in education, learning strategies and interactive teaching concepts, but despite there

being so much emphasis on safety and risk management concerns, there are also quality concerns

and variation in practice. The population used is a 400 bed public hospital, all RN’s on 3

surgical floors (25 RN’s total) with all employment types (full time, part time, and causal). They

hypothesized that a supportive clinical learning network, opportunities for practice, reflective

discussion and feedback helps to engage clinicians to think in a self-motivated process. The

researcher discusses previous “studies have examined whether education programs contribute to

nurses’ subsequent use of physical assessment skills” (p. 110). The researcher concludes that

when the nurses are actively engaged in a supportive learning system, it supports a healthier

framework for continuing education. Nurses that were younger, less experienced and better

educated were more likely to take up training opportunities. Important learning connections

were made during the sharing of perspective of the group. Key terms include continuing

education, educational model, and patient safety. The evidence that must be gathered by the

researcher includes standards, guidelines, and organizational data to support this study. The

outcomes will be measured by a pre and post test: comparing skills, seven practice activities, and

participants attitudes to performing respiratory skills and lastly determining short knowledge

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quiz relating to respiratory assessment using multiple choice answered questions. Supporting

nurses with continued education helps this article support the capstone project. Using

technology such as power points with continued education is a necessity to help keep RN’s

engaged and support the technological advances. Using power points with this capstone project

is a way technology can be incorporated into the education.

The author of the research article, Exploring Nurses' Knowledge and Perceived

Barriers to Carry Out Pressure Ulcer Prevention and Treatment, Documentation and Risk

Assessment, Kharabsheh et al. (2014) explores in their research what the nurses level of

knowledge of pressure injury prevention and treatment as well as perceived barriers. The

researcher believes the problem is the attitudes and knowledge of the caregiver (nurse), may be

affecting the care of the patient for pressure injury prevention. Currently, pressure injury

prevention programs consist of risk assessment, pressure injury documentation, training and

education, repositioning, and preventive measures. The researcher states the problem is

identified by unsatisfactory patient and organizational outcomes, safety and risk-management

concerns and quality concerns. The study was conducted in a hospital in Jordan containing more

than 200 beds with medical, surgical and ICU units. Three units were chosen by means of a

random number table from each site, and then all RN’s on the unit were surveyed that had a

Baccalaureate degree and involved in patient care. Pressure injury prevention had to be part of

their daily care and treatment. 45 item questionnaires were provided to each of the nurses to

assess pressure injury knowledge prevention and treatment equaling 216 nurses total. Each were

completed and returned. Other studies comparing to this one is similar except with different

methods, knowledge tests and evaluation criteria. The outcomes for this study are qualitative.

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Pressure injury preventions seem to depend on the knowledge of the nurse caring for that patient.

Possible search terms include pressure ulcers, knowledge, perceived barriers, and Jordan

Nursing. Evidence for this study that must be gathered includes publications, standards, and

organizational data. This study relates to the capstone project by supporting the learning

objectives: to be able to create a care plan based on those at risk, and the need for nurse

education regarding the use of risk assessment tools for optimum patient outcomes.

Educational Process

The author of the research article, Knowledge and Attitudes of Nurses Toward

Pressure Injury Prevention, Barakat-Johnson et al. (2018) explores in their research what the

knowledge and attitudes are for nurses on pressure injury prevention and if there is a relationship

between their attitude, knowledge and years experience. Understanding the knowledge and

understanding of pressure injury prevention is essential in identifying improved processes and

education and if not addressed could explain a large increase in pressure injuries. Current

practice shows there is a discrepancy in nurses being knowledgeable regarding skin integrity and

pressure injury prevention as well as a gap between evidence based practice and the nurses’

knowledge. The problem was identified using safety and risk-management concerns, variation in

practice within setting, and quality concerns. The population surveyed included: nurses in four

hospitals and five community settings in a local health district for a total of over 3,000. With a

total of 749 sufficient returned surveys to use for the data collection. Two valid instruments

were designed to assess attitudes and knowledge toward pressure injury prevention. A survey

was either given out via email or on paper depending on the facility. Their outcomes were

similar to other studies revealing that nurses have good knowledge and display positive attitudes

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towards pressure injury prevention, however the knowledge about pressure injury prevention was

described incorrectly in about 40% of those surveyed. The researcher suggests more research to

evaluate the relationship between attitude, knowledge and pressure injury prevention. They

observe there may be a connection between pressure injury prevention education and the

influence of pressure injury prevention. They also found there to be a significant connection

between knowledge, practice and attitudes. Possible search terms include knowledge, nurse

attitudes, and pressure injuries. The evidence that must be gathered by the researcher includes

publications, standards, and organizational data. The source connects to the capstone project

because it supports the learning objectives to identifying barrier to pressure injury prevention

interventions and how the standards focus on evidence based practice.

The research article Aliakbari et al. (2015), explore if a variety of theories should be

applied to educational activities. The researcher explains that not just one teaching model should

be used for educational purposes. Learning theories are divided into three categories:

behaviorism, cognitive and constructivism, with each being thoroughly explained. The theory of

cognitive focuses on the internal aspect of the learner and is useful for nursing education because

it involves observation, examples or patterns. Using this theory for this capstone project will

help the learner be able to focus their already known knowledge of the Braden Risk Assessment

tool and use their critical thinking skills to implement the necessary interventions.

The research article Cook (2013), explore which pressure ulcer screening assessment

tools works best for pressure injury prevention. Since pressure injuries are such a problem in

healthcare, preventable, and costly, determining risk factors early on can help with prevention,

although it’s more challenging in an ICU setting. Currently, there are several risk factor

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screening tools, but in the ICU setting they appear to be less helpful for pressure injury

prevention. The problem is identified using: safety and risk management concerns, quality

concerns, and unsatisfactory organizational and patient outcomes. The study identified ICU

patients, although they don’t give the population or patient demographics. Previous studies have

take a picture of the current pressure injury on a hospital unit, if the patient shows signs of a

pressure injury then it’s staged. Multiple studies show the incidence of pressure injuries in ICU

range from 10%- 41%. Other studies show implementing pressure injury prevention strategies

help to avoid a pressure injury, but in an ICU setting the risk factors vary more than the average

stable unit level patient. The outcomes are quantitative and the pressure ulcer data can be

collected to determine prevention outcomes as well as the number of interventions needing to be

placed for prevention. More qualitative data will need to be used to determine the patient’s

individual risk factors and what special interventions will be needed for pressure injury

prevention. Possible search terms include moisture, pressure injury prevention, and ICU

patients. Evidence that must be gathered by the researcher for this study includes publications,

standards, and organizational data. The researcher suggests future research to determine device

related pressure injuries and prevention, the effects of different medication and appropriate

pressure injury prevention risk screening tool. The article supports this capstone project because

it supports the use of the Braden Risk Screening Assessment Tool, applying interventions and

the ongoing need to identify those at risk as well as the learning objective for pressure injury

staging and areas at risk for skin breakdown.

Design

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The research article Poon (2013), explore the benefits of providing a blended

educational experience to students by an institutional method. The researcher shows how

educating students via face-to-face and online can be beneficial to enhance their learning. They

predict there is a significant relationship between the students’ experience, blended learning

strategy, and ultimate achievement. This article discussed how blended learning could help

promote student engagement, provide prompt feedback, provide a sense of community, effective

use of resources and increase student satisfaction. The research discusses how there have been

several courses that have used a blended method to deliver the educational information, and

twenty out of thirty reported having improved student outcomes. Blended learning also increases

autonomy and reflection, while embracing technology. They mention the challenges of using a

blended method for educational delivery are limited time for the universities involved, student

frustration from unrealistic expectations, and inability to support advanced technology. The data

was collected by interviews from undergrad aware recipient and a questionnaire for students all

with diverse disciplines. 200 questionnaires were returned and revealed the benefits of a blended

course are the flexibility to meet the needs of those whose learning styles vary. The face-to-face

time included seminars, field trips, laboratory time, and lectures. A flipped classroom is used to

prepare students by viewing the required technology based education before attending class. The

research discusses another benefit to a blended educational approach is beneficial for teachers,

hands-on education, and technology driven learning. The key terms to search for are blended

learning, institutional approach, and student learning experiences. This article supports this

capstone project due to the benefits of face-to-face learning combined with some technology-

based education, which is used for the educational strategies.

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Instructional Strategies / Blooms Taxonomy

The research article Taylor and Hamdy (2015), explore in what ways an adult learner

learns. Adults learn different than children, so the education being taught needs to be relevant

and incorporate their needs. This article explores the main types of learning theories and the way

each theory has developed into one another. The learning theories explored include

instrumental, humanistic, transformative, social, motivational, and reflective. Historically the

researcher discusses that learning derives from experiences, but as behaviorists become involved

in learning theories, they have determined an adult learner can learn by positive reinforcement.

Adult learners need to know why, self-concepts, readiness to learn, orientation to learning and

motivation for a successful learning session. Blooms Taxonomy can further promote learning

outcomes. Many adult learners use a variety of learning modalities to understand their intended

information. Evidenced gathered by the researcher includes publications and guidelines.

Possible search terms include learning theories, andragogy, and Bloom’s Taxonomy. The article

supports this capstone due to using the learning theory cognitive learning theories for the adult

learner to educate about the Braden Risk Assessment tool.

The author of the research article, Effective Lecturing (n.d), discusses how lecturing is

often slide presentations with monologue and can be done in an area with a large seating option.

Some instructors are more active, while others are less and focus more on the contents of the

material only. The concept of backward design should be used to ensure objectives are being met

while clarify any misunderstood information at the end of the session. They suggest using

repetition, make handouts relevant, assess prior knowledge, and break down the concepts. This

correlates to the capstone project because power point and lecture will be used to educate the

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nurses about the use of the Braden Risk Assessment tool, and although it will be a short

presentation, nurse engagement is still a necessity. This was also completed using a backwards

design, which includes the topic of education, meeting desired objectives, and determining how

the education then be relayed to the learner.

The research article Adams (2015), discusses how using the Blooms taxonomy

method for learning objectives promotes a higher cognitive skill level and therefore a deeper

learning and transfer of skills. The key terms for research include Bloom’s Taxonomy for

Learning Objectives, teaching, and cognition. This article discusses how Blooms Taxonomy

contains six categories of cognitive skills, which range from lower order skills to higher skills.

The stages of Blooms Taxonomy include: knowledge, comprehensive, application, analysis,

synthesis, and evaluation. The knowledge refers to the concrete information and process. The

comprehension includes being able to teach back the information being taught in their own

words and applying it to a situation for relevance. The next step is analysis, which refers to the

critical thinking skills. Next comes synthesis, which refers to applying the information to

specific situation and lastly is evaluation, which includes judging the value of the session. This

article supports the capstone project because Blooms Taxonomy is used to support the learning

objectives.

Learning Needs Assessment

A Learning needs assessment can be defined as closing the gap between what is

known and what is unknown. One will be able to more effectively provide education to their

audience when it’s known what the learner knows and what the learner doesn’t know. A

learning needs assessment helps to develop an educational strategy for learning to make them

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effective and for the objective of the course to be met (Grant, 2002). A learning needs

assessment will be given out before the education is initiated to determine the needs of the

nurses.

The author of the research article, The Lecturers Toolkit, Race (2014) discusses the

importance of knowing the needs of your learner so you can best provide their education

successfully. When giving education via lecture, it must be engaging for the learner and

incorporating the use of technology during a lecture can help with student learning. Being able

to provide something visually as well as verbally can help to cover a few ways an individual may

learn. Some students are more hands on, so the more senses that are introduced when

performing the education, the better the learner is likely to retain and use what they’ve been

taught. This can be incorporated into the capstone project by changing the approach to the power

point plan if the learner needs something other than a lecture form of education.

Evaluation According to the business dictionary, and evaluation is defined as a ”rigorous analysis

of completed or ongoing activities that determine or support management accountability,

effectiveness, and efficiency” (Business dictionary, 2018, para 1).

The research article, Designing Quality Multiple Choice Questions (n.d), discusses

how administering a test using multiple-choice questions can effectively assess student learning,

because of their flexibility, relatively easy implementation, and grade that allow the instructor to

use a variety of teaching strategies. The researcher discusses how using multiple-choice

questions can test recall, problem solving, and conceptual awareness. The breakdown of

preparing a multiple choice question and how it ties learning activities and objectives of the

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course is also explained. This data from this type of evaluation can be captured using

quantitative data. This relates to the capstone project because the test questions used before and

after will be multiple choice, so it will test the knowledge of the learners understanding after the

education is given.

The article Case-Based Learning (n.d), discusses how students use their world

knowledge to apply to case scenarios which promotes higher levels of cognition. This has a

strong history of successful implementation in the medical field. The researcher states how

using case- scenarios can help students collaborate learning, integrate learning and help develop

basic and extrinsic motivation to learn as well as encouraging self-reflection and development of

a variety of skills. The researcher discuss a study in which groups ranging consistently from 2 to

15 students, educators varied in the time they used case-based learning ranging from 2 hours to a

year. The instructor plays a passive role and help to keep the students engaged and enhance

thinking. This article supports this capstone project by incorporating the Blooms Taxonomy

scale for objectives and also incorporating case scenarios for learning strategies.

The author of the research article, How to assess students' prior knowledge, Carnegie

Mellon University (2016) discusses how it’s not enough to assess learners’ skills at the end of an

educational session, so administering a pre and post test can help to assess how much knowledge

they have gained throughout the course. There are a variety of options to use when assessing

their prior knowledge, which include portfolios, self-reports, classroom assessment techniques

(CAT’s), concept maps, and concept tests. A concept test can be used to assess current

knowledge or understanding of a course. Typically these tests consist of one to five multiple-

choice questions and are beneficial in large classroom settings where is may be difficult to assess

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the current knowledge of each individual student. The research states the questions must be

direct and distractors provided to reveal common errors. Search terms for this source include

concept tests, educational innovation, and Eberly Center. This article supports the capstone

project due to a pre and posttest being performed to assess to assess growth of the learner.

The research article Pritchard, M. (n.d.), discusses summative evaluation, which is

completed at the end of an educational session. The source discusses how the aim is to

determine if the project achieved the intended objectives, and uses both qualitative and

quantitative data collection. This provides awareness into the unintended consequences and

lessons for improvement. It also allows the educator to make future recommendations for

research and budgeting. Lastly, a summative evaluation allows a deeper understanding of the

process of change to gather knowledge for improvements. This evaluation will be used for this

capstone project to determine if the education the nurses received achieved the objectives that

were set as well as feedback to improve the education as well as the educator.

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Appendix 1- Braden Risk Assessment Tool

Goal

The goal of this capstone project was to develop, implement and educate nurses

regarding the use of the Braden Risk Assessment tool to help prevent pressure injuries and

increase awareness of interventions that can be implemented for prevention.

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Learning Objectives: Table 4

Table 4Capstone Objectives1. Design an educational module

a. Format: face-to faceb. Time-frame: 2 weeksc. Setting: Conference room on an acute hospital unitd. Sample and size: 20 Registered Nurses and/or Licensed Practical Nursese. Learning objectives: At the end of the learning session, the nurse will be able to:

Describe the purpose of the Braden Risk Assessment Tool Interpret the Braden Risk Assessment Scores Discuss what classifies as a stage 1 pressure injury Identify three pressure injury risk factors Justify two interventions for pressure injury prevention Complete the Braden Risk Assessment Describe two areas of skin breakdown concern from each case scenario Create a plan of care for the case scenarios that have a qualifying risk score from the Braden

Risk Assessment Verbalize how a nutrition referral is placed for their organization Identify 2 barriers of successful implementation of interventions

Design: Power point & Lecture and Case Scenario discussion1. Develop a nursing staff model for the delivery of the educational module

a. Obtain necessary approvals:i. Review plan with unit educator/ nurse manager

1. Determine logistics of planning, implantation and evaluation of educational projecta. Identify access to sample subjects: random, simple sampleb. Identify any limitations and restrictions: time frame to reach all staff, room

availability, staff timing during shiftc. Obtain all necessary approvals- verbal consent from participants

ii. Develop and implement a nursing needs assessment (NNA) with participants to:1. Determine sample participant demographics- RN and LPN2. Determine sample participant preferences via LNA3. Determine sample participants learning needs: Provide LNA before pre-test4. Format: Face-to-face5. Conduct pretest at same time as LNA6. Provide information for voluntary verbal consent to participate7. Determine hypotheses (usually 1-3) for associations to test with data received

from evaluation tools: a. Staff will be aware of use of Braden Risk Assessment. b. staff will be able to identify pressure injury risk areas. C. staff will be affected by their barriers as well as lack of understanding of implementing interventions based on Braden Risk Assessment scores.a. Identify plan for post module data analysis

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2. Develop the educational modulea. Complete current ROL and EBP (five years to date)b. Develop format, content and instructional strategies

4. Develop evaluation toolsa. Pretest/Posttest (questions are the same for each test)

i. Question Formatting: multiple choice, fill in the blank and case scenario ii. Purpose of tool: To determine baseline knowledge. The learner has met the objectives

when they receive 80% on post-test (8 out of10 questions)- 1 point per question iii. Plan for data analysis: list quantitative (statistical tests) and qualitative tests planned.b. Course evaluation including instructor evaluation i. Format: 5-point Likert-scale i. Purpose of tool: determine the effectiveness of educational content by meeting

learning objectives, educational strategies, and instructor effectiveness iii. Plan for data analysis: list quantitative (statistical tests) and qualitative tests planned5. Implement educational module.6. Evaluate results of data from evaluation tools: pre/ post test, course evaluation (minimum

tools are NNA, a. Collate and analyze data b. Present data and analysis in tables and figures to include in paper7. Write the review, evaluation, and summary and conclusions of the capstone project paper8. Devise a working plan to accomplish the capstone project and paper (Capstone Plan)

Capstone Plan – Table 5

Table 5Capstone PlanStep Action Item Start Date Completion

DatePlan for Completion of MSN 8400 5/14/2018 7/1/2018

1 Complete approved components of capstone paper ‘to date’ Problem Statement Theoretical Framework ROL Goal and Objectives Capstone Plan

6/14/186/2/20186/14/20186/14/20186/10/20186/17/2018

completeComplete

CompleteCompleteCompleteOngoing

2 Obtain clearance to proceed to Capstone 8500 from faculty member Completion and approval of development of educational

module “to date” Completion and approval of capstone paper to date Completion and approval of outcome measures (nursing

needs assessment, pre and post-test and course evaluation tools)

6/14/2018

5/21/2018

7/1/20185/28/2018

6/14/2018

6/17/2018

7/1/20186/3/2018

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Logistics of the implementation of the project Timeline for implementation, evaluation and final write-up

through MSN 85007/9/20187/9/2018

7/16/20188/19/2018

Plan for implementation of Project 7/16/2018 7/27/2018

3 Request permission from Education Department Send email to 7E SDS to gain approval for educational

module Approval obtained

7/9/2018

7/9/2018

7/9/2018

7/9/20184 Request approval from 7E Nursing Manager with face to face meeting

Email tentative dates to 7E manager Email 7E manager tentative dates in July for staff able to

attend and reservation of conference room Meeting date scheduled Approval received

6/27/2018

OngoingOngoing

OngoingOngoing

6/27/2018

OngoingOngoing

OngoingOngoing

5 Write a Needs Assessment Determine sample size: goal = 20 Voluntary Basis, Random Sample Contact participants/tentative date of module Write pretest/posttest and course evaluation Obtain faculty approval

Pretestposttestcourse evaluation

Send pretest to staff via face to face Receive completed pretests from all subjects

6/10/21086/10/20186/15/20187/16/20186/18/2018 7/9/20186/18/20186/18/20187/16/20187/16/20187/16/2018

6/17/20186/17/20186/17/20187/27/2018complete7/9/2018completecomplete7/27/20187/27/20187/27/2018

6 Receive and collate responses from Needs Assessment and pretest 7/27/10 8/6/2018

7 Date and Setting for Education Module Confirm date for reservation of setting Confirm exact number of staff (20 over 2 weeks)

7/16/20186/16/20187/16/2018

7/16/20186/16/20187/27/2018

8 Obtain current content for educational module Ongoing Ongoing9 Begin developing education module

Complete PPT on module ‘to date’Receive and utilize peer feedbackReceive and utilize faculty feedback

6/18/2018 6/24/2018

10 Finalize design of education module components Obtain faculty approval

7/8/2018 7/12/2018

Plan for Completion of MSN 8500

11 Collate data from pilot educational module Pretest and Posttest Course evaluation (including instructor evaluation) Display result and data in tables and figures

7/16/20187/16/20187/16/2018Ongoing

7/27/20187/27/20187/27/2018Ongoing

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12 Complete Capstone Paper Complete review of capstone section Complete evaluation of capstone section Complete summary and conclusion section Complete abstract section

Identify keywords

Ongoing Ongoing

13 Final Review of Capstone Project Obtain Faculty Approval Final Submission Signed Library Release

Ongoing Ongoing

14 Prepare Poster Presentation Ongoing Ongoing15 Complete Graduate Reflections Paper Ongoing Ongoing17 Poster Presentation Ongoing Ongoing

Appendix A

Learning Needs Assessment Tool- Table 6 Table 6Learning Needs Assessment Tool

1. My highest degree of education5 - Phd 4- MSN 3-BSN 2-ADN 1-

Diploma/ LPN2. Years practicing nursing5=30-40 4=29-20 3=19-10 2=9-1 1= <13. My interest in pressure injury prevention5-very interested 4-moderatelyinterested 3-somewhat interested - 2- less than

somewhat interested 1- no interest4. I learn best by5- Hands-on 4- reading material 3-discussion 2- lecture 1- all of the above5. I feel as if I have the necessary resources to adequately complete pressure injury preventions

5 - always 4- usually 3-sometimes 2- rarely 1- never6. Please include any other comments

27


Appendix BLearning Needs Assessment: Data Set and Analysis – Table 7

Table-7Learning Needs Assessment Questions: Scores Pre and Post Education (n=#) Participant

Ratings: Pre Education

High (5)

Moderately high

(4)

moderate(3)

Moderately low

(2)

Low(1)

x̅

(# (%)

(#) (%) (# (%)

(#) (%) (#) (%)

R) (%)

1. My highest degree of education

2. My years practicing nursing

3. My interest in pressure injury prevention

4. I learn best by:5. I feel as if I have

the necessary resources to adequately complete pressure injury preventions

Σ x̅6. CommentsParticipant

Ratings: Post Ed.

(5) (4) (3) (2) (1) x̅

(# (%)

(#) (%) (# (%)

(#) (%) (#) (%) (R)

(%)

1. Current education level

2. Years practicing3. Current interest4. Learn best by5. Feel as if

resources are available

Σ x̅

Learning Needs Assessment Questions: Change in Scores Pre and Post EducationParticipant Questions Pre Education Post Education ∆

x̅ (%) x̅ (%) x̅ (%)

30


Current education levelYears practicingCurrent interestLearn bestResources are availableOverall Σ x̅ (%)Legendx̅ = meanR= rating scale mean # = number frequency%= percent of total∆ = change

Appendix C Course 8500Pre and Post Test with Answer Key

Table 8Pre and Post Test Tool# Question LO1. What is the purpose of the Braden Risk Assessment Tool? 1a To help prevent skin breakdown (correct)b To help with assessment of skinc To help with mobility assessmentd To help with prediction of hydration status

2. A score of less than _?_means the patient is at risk for a pressure injury 2a <20b <18 (correct)c <15d <12

3. What characteristic classifies a sage 1 pressure injury? 3a. Broken skin over a bony prominenceb. Red, blanchable skin over a bony prominencec.. Purple area over sacral regiond. Non-blanchable redness, over intact skin over a bony prominence (correct).4. What are 3 pressure injury risk factors? 4a. Bowel and bladder incontinence (correct)b. Immobility (correct)c. finishing most meals that consist of French fries, soda and candyd. Neuropathy (correct)

5. What are 2 options for pressure injury interventions? 5a. Turning q2 hours (correct)b Incontinence care with turns and as needed (correct)c Assessing social issues for help

2


d. Providing Nail Caree. Constipation relief

6. Based on the Case Scenario: what is the score of the Braden Risk Assessment? (use braden risk tool attached)

54 y.o. female admitted for back surgery. Since surgery, she’s had decreased sensation and movement to her LLE. She’s unable to walk and insists on keeping her foley catheter in due to fear of loss of bladder function and is continent of bowel. She eats 50% of her meals most of the time.

6

a. 8-9b. 11-12c. 13-15 (correct)d. 18-20

7. Based on the above case scenario, choose 2 areas at risk for a pressure injury?30 y.o male diagnosed with new paraplegia from a car accident. He’s unable to move his legs, has no sensation from nipple line down and is therefore incontinent of bladder and bowel. He’s been eating 50% of his meals due to some depression from his new diagnosis.

7

a. Sacrum (correct)b. Back of headc. Elbowsd. Between knees (correct)e. Left heel onlyf. Both heels (correct)

8. Choose 3 components to create a skin care plan based on the above patient scenario. 8a. Consult nutrition (correct)b. OOB in chair all day for activitiesc. Turn q2 hours (correct)d. Elevate only one heel at a timef. Allow patient to shift weight as he desires

9. What is the wording used to place a nutrition referral ? 9a. Consult nutritionb. Nurse referralc. Nutrition consult

10 What are 2 barriers that may prevent you from successfully implementing necessary interventions to prevent pressure injuries?

10

a. Lack of timeb. Patient acuityc. Lack of equipmentd. Don’t care much about pressure injury preventione. Patient refusal

3


f. Unsure of how to perform adequate turns

Appendix D Course 8500Pre and Post Test Data Set and Analysis

4


5

Table 9Pre Test Data Set and Analysis (n= ?)Q LO 1 2 3 4 5 6 7 8 9 10 x̅

n # % # % # % # % # % # % # % # % # % # %1234567891011121314151617181920

% % % % % % % % % % %Σ x

Post Test Data Set and Analysis (n= ?)12345678 9

101314151617181920

% % % % % % % % % % %Σ x̅

Legendn= sample sizex̅ = sample meanΣ x̅ = total mean∆ = changeQ= question #LO= learning objective #


Appendix E Course 8500Pre and Post Test Data Set: Analysis of Change from Pre to Post Test Scores

Table 10Change in Pre to Post Test Scores (n=?)

Q LO Pre Test x̅ (%) Post Test x̅ (%) ∆ x̅ (%)1 12 23 34 45 56 67 78 89 9

10 10Σ x̅

Legendn=sample sizex̅ = sample meanΣ x̅ = total mean∆ = changeQ= question #LO= learning objective #

Appendix FCourse and Instructor Evaluation Tool: Data Set and Analysis

Table 11Instructor and Course Evaluation Tool: Data Set and Analysis (n=?)Rating Scale 5 4 3 2 1

Course Content andLearning Objectives Questions

StronglyAgree

Agree

Neutral Disagree StronglyDisagree

x̅

Q # % # % # % # % # % R %1. Overall, the educational module was excellent2. The educational module was well organized3. The Learning objectives were identified at the beginning of the moduleCourse Evaluation Σ x̅4. Overall, the education met the stated Learning Objectives4.1. I can describe the purpose of the Braden Risk Assessment Tool4.2. I can interpret the Braden Risk

6


Assessment Scores4.3. I can discuss what classifies as a stage 1 pressure injury4.4. I can identify three pressure injury risk factors4.5. I can justify two interventions for pressure injury prevention4.6 I can complete the Braden Risk Assessment4.7 I can describe two areas of concern from the case scenario4.8. I can create a plan of care for the case scenarios that have a qualifying risk score from the Braden Risk Assessment4.9. I can verbalize how a nutrition referral is placed for my organization4.10. I can identify 2 barriers to successful implantation of interventionsLO Evaluation Σ x̅

LNA Questions1) My highest degree of education2) Years practicing nursing3) My interest in pressure injury

prevention4) I learn best5) I feel as if I have the necessary

resources to adequately complete pressure injury preventions

6. My knowledge in pressure injury prevention area has increased.7. My interest in pressure injury prevention has increased.8. My application of knowledge in pressure injury prevention will increase.9. My increased knowledge in pressure injury prevention will improve my current practice.LNA Evaluation Σ x̅

Instructor Evaluation10. Overall, the instructor was excellent11. The instructor used instructional methods effectively to promote learning12. The instructor was knowledgeable in the pressure Injury prevention via use of the Braden Risk Assessment Tool

7


12. The instructor provided an opportunity for questions and answersInstructor Evaluation Σ x̅

Participant Comments13. What recommendations or modifications do you have to improve the educational module?14. Please share any other comments.Legend n= sample size x̅ = mean R= rating scale mean # = absolute frequency %= relative frequency

References

Adams, N. E. (2015). Bloom’s taxonomy of cognitive learning objectives. Journal of the

Medical Library Association : JMLA, 103(3), 152-153. doi:10.3163/1536-

5050.103.3.010.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511057/

Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (2015). Learning theories application in

nursing education. Journal of Education and Health Promotion, 4(2). doi:10.4103/2277-

9531.151867 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355834/

Barakat-Johnson, M., Barnett, C., Wand, T., & White, K. (2018). Knowledge and Attitudes of

Nurses Toward Pressure Injury Prevention. Journal of Wound, Ostomy and Continence

Nursing, 45(3), 233-237. doi:10.1097/won.0000000000000430

https://vnet.christianacare.org/sp-3.30.0b/,DanaInfo=ovidsp.tx.ovid.com+ovidweb.cgi?

&S=LPFFFPECPADDONHHNCEKLEGCNLOOAA00&is_ajax_call=1&Open+Link=S

.sh.22.43%7c0%7c

8


Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013). Pressure Ulcers and Prevention

Among Acute Care Hospitals in the United States. The Joint Commission Journal on

Quality and Patient Safety, 39(9), 404-414. doi:10.1016/s1553-7250(13)39054-0

https://www.jointcommissionjournal.com/article/S1553-7250(13)39054-0/abstract

Carnegie Mellon University. (n.d.). How to assess students' prior knowledge - Eberly Center -

Carnegie Mellon University. Retrieved from

https://www.cmu.edu/teaching/assessment/priorknowledge/

Case-Based Learning | Center for Teaching and Learning. (n.d.). Retrieved from

https://ctl.yale.edu/faculty-resources/strategies-teaching/case-based-learning

Cooper, K.L. (2013). Evidence- Based Prevention Ulcers in the Intensive Care Unit. Critical

Care Nurse, 33(6), 57-66. doi:10.4037/ccn2013985

https://vnet.christianacare.org/sp-3.30.0b/,DanaInfo=ovidsp.tx.ovid.com+ovidweb.cgi?

&S=JHPJFPJEEKDDONKHNCEKMEOBFGHCAA00&Link+Set=S.sh.49%7c2%7csl_

10

Designing Quality Multiple Choice Questions | Center for Teaching and Learning. (n.d.).

Retrieved from https://ctl.yale.edu/MultipleChoiceQuestions

Dorothea Orem's Self-Care Theory. (2012). Retrieved from

http://www.currentnursing.com/nursing_theory/self_care_deficit_theory.html

Duff, B., Gardner, G., & Osborne, S. (2014). An integrated educational model for continuing

nurse education. Nurse Education Today, 34(1), 104-111. doi:10.1016/j.nedt.2012.11.022

https://www.researchgate.net/profile/Beverley_Duff/publication/233983537_An_integrat

9


ed_educational_model_for_continuing_nurse_education/links/

59e1a5f0a6fdcc7154d7d1de/An-integrated-educational-model-for-continuing-nurse-

education.pdf

Effective Lecturing | Center for Teaching and Learning. (n.d.). Retrieved from

https://ctl.yale.edu/EffectiveLearning

Grant, J. (2002). Learning needs assessment: Assessing the need. Bmj, 324(7330), 156-159.

doi:10.1136/bmj.324.7330.156 https://www.bmj.com/content/324/7330/156

How to write a literature Review. (n.d.). Retrieved from

https://library.concordia.ca/help/writing/literature-review.php?guid=purpose

How has this term impacted your life? (2018). Retrieved from

http://www.businessdictionary.com/definition/evaluation.html

Hyun, S., Vermillion, B., Newton, C., Fall, M., Li, X., Kaewprag, P., . . . Lenz, E. R. (2013).

Predictive Validity of the Braden Scale for Patients in Intensive Care Units. American

Journal of Critical Care, 22(6), 514-520. doi:10.4037/ajcc2013991

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042540/

Jacobs, G., Witteloostuijn, A. V., & Christe‐Zeyse, J. (2013). A theoretical framework of

organizational change. Journal of Organizational Change Management, 26(5), 772-792.

doi:10.1108/jocm-09-2012-0137

https://www.emeraldinsight.com/doi/abs/10.1108/JOCM-09-2012-0137

Kharabsheh, M., Alrimawi, R., Assaf, R., & Saleh, M. (2014). Exploring Nurses' Knowledge and

Perceived Barriers to Carry Out Pessure Ulcer Prevention and Treatment, Documentation

10


and Risk Assessment. American International Journal of Contemporary Research, 4(4),

112-119. http://www.aijcrnet.com/journals/Vol_4_No_4_April_2014/15.pdf

Moore, Z. E., & Cowman, S. (2014). Risk assessment tools for the prevention of pressure ulcers.

Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd006471.pub3

http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006471.pub3/full

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk Assessment and Prevention

of Pressure Ulcers: A Clinical Practice Guideline From the American College of

Physicians. Annals of Internal Medicine, 162(5), 359. doi:10.7326/m14-1567

http://annals.org/aim/fullarticle/2173505

Poon, J. (2013). Blended learning: An instit utional approach for enhancing students' learning

experiences ,. Journal of Online Learning and Teaching, 9(2), 217-288.

http://dro.deakin.edu.au/eserv/DU:30057995/poon-blendedlearning-2013.pdf

Pritchard, M. (n.d.). Summative Evaluation. Retrieved from

http://www.evaluationtoolbox.net.au/index.php?option=com_content&id=40

Race, P. (2014). The Lecturers Toolkit. doi:10.4324/9781315767277

https://books.google.com/books?

hl=en&lr=&id=d1CcBQAAQBAJ&oi=fnd&pg=PP1&dq=learning+needs+assessment&o

ts=eCdxctzulQ&sig=_ojgZ1dFuSVy2u_gvVahmRsWXbk#v=onepage&q=learning

%20needs%20assessment&f=false

Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and

teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11).

11


doi:10.3109/0142159x.2013.828153

https://www.tandfonline.com/doi/full/10.3109/0142159X.2013.828153

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