Introduction

Teaching portfolio has been extensively used in education programs for nursing to help facilitate the teachers’ growth and document teaching effectiveness. Marilyn & Oermann (1999, p. 224) defined a portfolio as a compilation of carefully selected materials that describes the teaching activities of a faculty member in the clinical, classwork, and other settings. The paper aims to develop a portfolio related to the educational program’s design process and reflects on those experiences. This program portfolio is a completed framework for an education program designed and ready for implementation. King Fahad Central Hospital will be the venue where the program will be conducted, particularly targeting registered nurses. The plan will address objectives for all education sessions, content outline, teaching plan, and resources list with costing, evaluation strategies with evaluation tool prepared, reflection on the process you have undertaken, and finally, a conclusion.

Aims of the program

The program aims to enable the registered nurses at king Fahad Central Hospital to understand the rationale for Personal protective equipment, recognize the current PPE products and enhance their adherence to the recommended Personal protective equipment guidelines.

Objectives for all education sessions

Upon completion of this four-week program, the registered nurses of King Fahad Central Hospital will be able to:

1. Understand the relationship between the prevention of associated infections and personal protective equipment and
2. Understand the effectiveness of PPE
3. Be able to apply the involved steps in the effective use of PPE
4. Identify the factors that affect adherence to protocols for using Personal protective equipment

Content outline in detail

WEEK ONE

Module 1: Introduction to personal protective equipment

Presenter: Bashehab Omnia

Personal protective equipment (PPE) is equipment or clothing worn by an employee for protection against infectious materials. PPE worn by nurses prevents contact with the patient’s body fluid that has infectious or even infectious agents by creating a barrier between a healthcare worker and the potentially infectious materials (Pang, 2014). In a hospital, the components of PPE include goggles, face shields, eye protection, respirators, masks, head covers, shoe covers, gowns, and gloves (McDonald & Ness, 2015).

Wearing protective equipment for the body can considerably reduce health risks for nurses exposed to body fluids or blood. Employers must maintain and provide clean appropriate PPE and clothing to the employees free of charge (Dixon & Ong, 2014). Personal protective equipment must be available and accessible to nurses in appropriate sizes. It is also important for healthcare workers to know the type of PPE available and where it is stored. It is significant for registered nurses to protect themselves by donning a barrier between them and anything that is potentially infectious.

As described by CDC, PPE use is built to the description of all four precautions (airborne, droplet, contact, and standard). Therefore, PPE selection should consider the possibility of contacting infectious material through airborne pathogens, respiratory droplets, the anticipated volume of exposure, and splashes. This depends on the procedures performed by the nurses. Additionally, consideration should be given to whether the PPE protection is from exposure to healthcare workers, patient safety, or both (Department of Health, 2014).

PPE is most effective when selected appropriately, fitted properly, worn according to the manufacturer’s instructions, frequently inspected for integrity verification, and changed between patients.

According to Pellowe et al. (2004), the type of PPE chosen should be based on the reasonably anticipated events and procedures, such as:

• Body fluid or blood splash
• Contact with minimal bleeding/body substances/drainage
• Contact with a large amount of bleeding/body substances/drainage that is likely to soak through the area of contact
• Airborne pathogens
• Respiratory droplet pathogens

Outcomes

The learners will have understood the general information about PPE, like their importance, what they are, how to get them, procedures, and most PPE use in hospital settings.

Module 2: Types of PPE and when they should be used

Presenter: Bashehab Omnia

Outcome

The nurses shall understand the different types of PPE available in hospital settings, showing the visual images of the PPE and where they are used. They will be in a position to understand their importance.

WEEK TWO

Module 3: Respiratory protection

Healthcare workers or patients for pathogens transmission use respirators, masks, and powered air-purifying respirators (PAPRs). Examples of respiratory protection include the following:

1. Single-use disposable masks for precaution against droplets. Are used for suspected TB patients or patients with respiratory symptoms as part of hygiene
2. Disposable masks with eye shields are used by nurses when splatter or splash is anticipated. Both nurses and patients use them.
3. N-95 respirators are used by healthcare workers for airborne precautions, especially when caring for patients suspected or known to have pulmonary TB. They should be worn as instructed on the package of the product for maximum protection.
4. PAPRs are also used instead of or in addition to N-95 respirators as an airborne precaution (McDonald & Ness, 2015).

All the protection for respiratory should cover both nose and mouth and be securely fitted to prevent inhalation and exhalation of pathogens and to prevent fogging of the eyeglasses. Similarly, masks with strings should be tied securely to prevent them from coming loose during the procedure.

Outcome

As the nurses become aware of the importance of respirator protection, they will see the need to protect themselves and the patients at work from airborne infectious diseases.

Module 4: Head, hand, body, and foot protection

Masks

Face protection with an eyelid shield, mask, face shield, or goggles protects the mucous membrane of the nose, eye, and mouth during procedures that have the possibility of generating sprays and slashes or body flu or blood since mucous membranes are the second most route for the viruses transmitted through blood after invasive injuries.

Gloves

These are items used once by the nurses for invasive procedures on patients, which include the mucous membranes, contact with sterile sites, and other activities that carry the risk of blood exposure, infectious respired droplets or aerosols, and body fluids. Moreover, they should also be removed immediately when the nurses have finished offering caring services, and hands should be decontaminated after the glove have been removed. Lastly, gloves should be changed when soiled and not decontaminated or washed with alcohol products when performing the procedures.

Gowns and aprons

Gowns and aprons are also single-use items worn when in contact with equipment, material, or patients that pose contamination risk with body fluids or blood. Healthcare workers should ensure gowns are changed when it’s visibly soiled and are worn only for one episode of a patient or procedure only (Pellowe et al., 2014).

Footwear

The water repellent or wellington boots should be put on by the nurses when there is a likelihood of risk of body fluid/blood splashes, large amounts of spillages or leaks, and spillages such as oesophageal bleeds in theatre rooms. The following consideration should be taken into account if the footwear is required:

• Hands can be contaminated by pulling or touching the footwear after its surface has been contaminated during patient care.
• Removing footwear and standing in the same area will contaminate the feet. A dirty area for the removal of footwear should be secluded and clean where there is no contamination.
• Footwear should be used once, and if reused, the manufacturer’s instructions should d be followed (Pang, 2014).

Outcome

Nurses can now apply their knowledge to protect their heads, faces, body, and legs during work. They will know how to use the PPE for the head, body, and legs and their significance in a hospital setting.

WEEK THREE

Module 5: PPE rules to follow

1. Putting on PPE

The sequence below should be followed when putting on PPE:

• Decontaminate the hands before touching and wearing the PPE
• Put on plastic gowns or aprons
• Put on gloves (Dixon & Ong, 2014).

1. Removing PPE

To minimize cross/self-contamination risk, The PPE must be removed following the sequence below:

• Gloves first
• Gown/apron
• Respirator/mask when won
• Decontamination of the hand after PPE removal

Gowns and aprons should be removed from the body by pulling them away from the shoulders/face and rolling downwards to fold the contaminated surface inwards, only exposing the inner surface, which is clean.

Visors and masks should be removed by pulling securing devise or strings away from the sides of the face (Department of Health, 2014).

1. Disposing PPE

The PPE used by the nurses when providing their services to non-infectious patients can be disposed of in infectious or clinical waste streams or offensive waste. However, PPE used on infectious patients must be disposed of into clinical infectious waste streams for incineration.

1. Enhanced PPE

These must be used with patients of high risks, such as Ebola virus disease. These are updated continually and therefore have no specific guidelines and need expert guidance when they occur (Pellowe et al., 2004).

Outcomes

The nurses must know the proper ways of putting on and removing the PPE in the correct sequence and maintaining hygiene.

WEEK FOUR

Module 6: Summary

The nurses under training will recap what has been learned throughout the four-week training, discuss in groups, and ask questions as they prepare for the quiz at the end of the training.

Outcome

Recap everything learned throughout the four weeks using videos, class presentations, visual images, class discussions, tests, questioning, and pair-share discussions.

Quiz

This will be to test their understanding of the concepts taught during the training.

Teaching Plan

Resources List

Evaluation Strategies with Evaluation Tool Prepared

1. Observation

Formative peer observation helps improve teaching (Johnson, Mims-Cox, & Doyle-Nichols, 2006). On the other hand, summative peer observation involves assessing the effectiveness and efficiency of teaching used for tenancy in promoting teachers and the merit of decisions. Peer classroom observations are effective because they offer insights regarding improving the individual needs of the learners and improving teaching. Moreover, the teachers will gain new perspectives and ideas about teaching through observation from their colleagues. This will improve the ability to teach (Johnson, Mims-Cox, & Doyle-Nichols, 2006)

1. questioning

It is one of the evaluation methods used by teachers naturally daily in the classroom in testing whether the learners have understood, learned, and progressed ultimately against the defined learning objectives at the start of the session (Gravells, 2013).

1. Tests/ End week quizzes

These are undertaken while the students’ learning is taking place to improve the learning and teaching of the individual students. They are effective since they capture the student’s progress in a program or the institution (SQA, 2001). The test will be done weekly at the end of every training week. The sample test, which acts as an evaluation tool, is in Appendix 1

1. Professional discussion

It provides a holistic approach when conducting knowledge evaluation and understanding. The method is useful and effective in determining the performance of the candidate and also the candidate’s abilities in decision-making and analysis. SQA (2001) asserted that the professional discussion method is one of the best ways of testing the reliability and validity of the candidates’ evidence

1. Assignment/Final Quiz

This problem-solving exercise has a clear structure, guidelines, and specified length. According to Johnson, Mims-Cox, & Doyle-Nichols (2006), assignment is specifically suited to the learning outcomes evaluation concerned with the application of the learning skills and the knowledge and understanding related to a situation involving the management of tasks. The assignment is effective as an evaluation method since its development is relatively straightforward. It can also access a wide range of both practical and cognitive competencies. Furthermore, it provides the candidates with a good opportunity of demonstrating initiative. Lastly, Gravells (2013) stated that it could be used in integrating evaluation across units and outcomes.

1. Case study-

According to SQA (2014), it consists of an event description normally in a text, electronic recording, or a picture that concerns a real situation. The case study is followed by multiple instructions prompting the candidate to analyze the situation, identify core issues and make conclusions before making suggestions or decisions on the course of action. Case studies are effective as an evaluation tool since it provides good opportunities for nurse learners to exercise skills in decision-making and problem-solving during the training. Furthermore, it allows the nurses to demonstrate their skills in time management, information gathering, and analysis applicable in a hospital setting. A sample of a case study is in appendix 2

Reflection on the process

The detailed education program portfolio has been quite an experience for me in understanding how to organize a training program. I have learned that before any learning takes place, there should be aims and objectives that need to be met at the end of the learning process. I have also learned that content should be outlined and how it will be taught to the students to avoid giving too much or even giving out less information. This calls for proper planning in the form of a teaching plan. Similarly, resources must be recorded and priced accordingly for the training session to go smoothly. For instance, I understood that some essential items need to be put in place before proper learning can take place, such as a conducting learning environment in the form of the lecture hall, writing materials, and supporting materials such as instructional videos, charts, and handouts—lastly, food for energy to the students and the teachers.

The most significant factor in meeting the learners’ needs is understanding their learning requirements and needs. This has been my foundation for achievement in my evaluation practice, especially in the classroom environment. This program is planned to accommodate 24 registered nurses. Therefore I believe the evaluation strategy I chose for individual evaluation for every student will need an understanding of each need and support for them to achieve the set objectives. My evaluation will be effective since I will also use other multiple evaluation methods, such as observation and professional discussion, allowing the registered nurses to achieve maximally and holistically. Moreover, my evaluation practice will be effective because the way I planned for the education program will be to finish the training earlier to the satisfaction of the students.

However, as my training program is ambitious, certain areas need improvement. Enough resources are needed to meet the learners’ needs for each of the modules that will be taught. The first area that will need improvement is the development of new resources and the learning processes since the resources available are limited because of the limited budget.

Secondly, I need to improve on adopting online and digital methods of evaluations like e-evaluations. This is because of their reliability compared to other methods. Moreover, e-evaluation is easy to use where there are many learners. Moreover, it is easier to compare the evaluation results from different learners than using the observation method in conducting the evaluations. E-evaluation was not incorporated as an evaluation strategy because of limited resources, and the learning was interactive and involved the active participation of the nurses in attendance.

I also think I should involve my students more in the evaluation process and monitor their skill development and progress. This is because the learners are involved in the training. After all, they want to develop the knowledge and skills needed to complete their training course, get the skills, and then apply them in their places of work.

Conclusion

In conclusion, the paper presented a nursing education program that will be implemented for 24 registered nurses of King Fahad Central Hospital. The education plan majorly centered on PPE techniques. The education plan aims to enable the registered nurses at king Fahad Central Hospital to understand the rationale for Personal protective equipment, recognize the current PPE products and enhance their adherence to the recommended Personal protective equipment guidelines. The content will also be taught on PPE, with the teaching plan running for four weeks. The strategies of evaluation that will be applied include observation, case studies, questioning, tests and quizzes, and professional discussions. Finally, the paper presented personal reflection before concluding.

References

Department of Health,. (2014). Management of Hazard Group 4 Viral Haemorrhagic Fevers and Similar Human Infectious Diseases of High Consequence. Retrieved 22 June 2015, from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377143/VHF_guidance_document_updated_19112014.pdf

Dixon, J., & Ong, E. (2014). Clinical Management of Viral Hemorrhagic Fevers. Current Treatment Options In Infectious Diseases, 6(3), 245-255. doi:10.1007/s40506-014-0022-4

Gravells, A. (2013). The award in education and training. Los Angeles, California: SAGE.

Johnson, R. S., Mims-Cox, J. S., & Doyle-Nichols, A. (2006). Developing portfolios in education: A guide to reflection, inquiry, and assessment. Thousand Oaks, Calif: Sage Publications.

McDonald, M., & Ness, S. (2015). Infection Control – Nursing Continuing Education Course. Nursingceu.com. Retrieved 22 June 2015, from http://www.nursingceu.com/courses/485/index_nceu.html#ppe

Pang, V. (2014). How to use personal protective equipment. Nursingtimes.net. Retrieved 22 June 2015, from http://www.nursingtimes.net/how-to-use-personal-protective-equipment/5077659.article

Pellowe, C., Pratt, R., Loveday, H., Harper, P., Robinson, N., & Jones, S. (2004). The epic project. Updating the evidence-base for national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England: a report with recommendations. British Journal Of Infection Control, 5(6), 10-16. doi:10.1177/14690446040050060301

Scottish Qualifications Authority. (2001). Guide to internal moderation for SQA centers. Glasgow: Scottish Qualifications Authority. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCIQFjAA&url=http://www.sqa.org.uk/files_ccc/ProfessionalDiscussion.pdf&ei=VlqiVKuqGoOAzAOPs4CQCw&usg=AFQjCNEmQ0k81HwhkjtiYiU__r2ft3ZbZA&sig2=UQ4WNDtx642VM1OKCk6wUA&bvm=bv.82001339,d.ZGU

Scottish Qualifications Authority. (2014). Internal Assessment, External Assessment, and Assessment for Learning — a think piece for those involved in developing assessments. (2014, January 1). Retrieved December 30, 2014, from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CCkQFjAB&url=http://www.sqa.org.uk/files_ccc/25GuideToAssessment.pdf&ei=VlqiVKuqGoOAzAOPs4CQCw&usg=AFQjCNHimFgXezPk-X8HlGSKZW94HkSMiA&sig2=iFz8zIK5iTW2A_b17JdJqQ&bvm=bv.82001339,d.ZGU

Appendices

Appendix 1

Sample test/Quiz

Question 1

A 12-year-old patient is brought to the hospital and has a day history of body aches, coughs, and fever and has stated that his friend has the flu. At the check-in desk, he is given a mask, instructed on how to cough with etiquette, and then taken to a private room to wait for an examination. He takes off the mask while inside the exam room and coughs actively while you walk in to assess him. What would you do?

[A] You never get sick, so you do not use any PPE

[B]only wear gloves since respiratory illnesses are normally transmitted by contact

[C] Perform hand hygiene and then wear eye protection and a mask since you will be with the coughing patient 3-6 feet during the assessment

Question2

You observe your co-worker looking quite ill and coughing when starting your shift. When you enquired how she was feeling, she answered that she would have stayed home from work but does not have any paid time off. Moreover, she would not like to inconvenience her co-workers by taking time off. What would you do?

[A]discuss with your colleague the possibility of her spreading her illness to patients and even other staff members, and it is good if she gets checked up

[B]disregard the sick co-worker because it is not your business

[c] Report to the manager or supervisor

[D] Both A and C

Question 3

According to CDC, what is the correct sequence for donning PPE?

1. Gown
2. Eye protection
3. Hand hygiene
4. Gloves
5. Respiratory protection

Question 4

According to CDC, what is the correct sequence for doffing PPE?

1. Eye protection
2. Hand hygiene
3. Respiratory protection
4. Gloves
5. Gown

Appendix 2

Mary is a nurse stationed in the GI procedure room and is making some preparation for an emergency endoscopy for a new patient having an active oesophageal bleed. The new patient is expected in the procedure room and is being stabilized in the emergency department. Mary reviews the PPE needed in this case and thinks the patient will be bleeding on arrival. What should Mary do?

Herman Bailey

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