Massive Transfusion Protocol (MTP) for nurses in the ICU with varied experience levels

1. Adult Learning Theory (Andragogy)

1.1. Theorist

1.1.1. Malcolm Knowles

1.2. View of Knowledge

1.2.1. Knowledge is more interesting if it has immediate relevance to their jobs and personal life

1.2.2. New knowledge is built on reflection on past and current experiences to learn over time

1.3. View of Learning

1.3.1. Adult's motivation to learn is pragmatic and their readiness to learn develops from life tasks and problems

1.3.2. Adults have preferred differences in personal learning styles and want to learn useful information that can be easily adapted

1.4. Role of the Student

1.4.1. Be actively involved and use their past experiences to apply new knowledge to solve real-life problems

1.4.2. Participation, negotiation, and a focus on the meaning the learning has on their life is key; Capable of directing or at least assisting in the planning and implementation of their own learning

1.5. Role of the Educator

1.5.1. Must connect the information as personally relevant to the learner and provide a broad variety of resources

1.5.2. Must develop a relaxed, psychologically sage environment that facilitates student empowerment and allows active involvement

1.5.3. Collaborates, guides, and sequences learning experiences to learner readiness and develops collaborative contracts

1.6. How this theory informs my instruction of MTP

1.6.1. It is important to emphasize relevance of what is being learned to the student's future practice. Providing escalating self-study activities, like on a learning management system, can build on past transfusion experience and provide background knowledge on the scenarios requiring MTP and the correlation on timing and outcomes. A date and list of what skills will be judged could be provided prior to a final hands-on competency in a simulation lab is conducted with debriefing at end that provides positive and negative feedback to learn from.

2. Experiential Learning Theory

2.1. Theorist

2.1.1. Carl Rogers

2.2. View of Knowledge

2.2.1. Knowledge is obtained for a desire to learn and an openness to change

2.2.2. Knowledge is obtained through reflection, analysis, and synthesis

2.3. View of Learning

2.3.1. Humans have a propensity to learn and significant learning takes place when the content is relevant to the learner and is self-initiated

2.3.2. Learners learn from risk-taking, success, and even failure but learning proceeds faster when the threat to self is low

2.4. Role of the Student

2.4.1. Needs to participate completely with self-initiation, have control over the direction of the learning, and value the learning

2.4.2. Self-evaluation is the principal method of assessing progress or success

2.5. Role of the Educator

2.5.1. Should facilitate, not dominate the learning process, to create experiences that have learners fully engaged, allow them to make decisions, and demonstrate their accountability

2.5.2. Set a positive climate for learning, clarify the purpose of the learning, organize resources to be available, balance intellectual and emotional components of learning, and share feelings and thoughts with learners without dominating

2.6. How this theory informs my instruction of MTP

2.6.1. Using this theory for MTP, educators can facilitate a learning process in a simulation lab where the risk to self and others is low. Learners can pick their own role for the scenario and use available resources the educator provides in the lab to navigate the scenario. Students can be allowed to make mistakes, while the instructor uses the simulator to show them real time what happens from the errors. Debriefing afterword, including an exploration of emotions that they felt during the scenario and feedback provided can help them to succeed in the future.

3. Socio-cultural Learning Theory

3.1. Theorist

3.1.1. Lev Vygotsky

3.2. View of Knowledge

3.2.1. Knowledge is obtained through the support of an expert, then gradually increases responsibility for mastering the knowledge, skill, or attitude

3.2.2. Faculty "scaffold" for students to increase self-awareness about what they know and how the new knowledge fits into their existing knowledge bank; creating meaning from experience

3.3. View of Learning

3.3.1. Learners learn as they learn; Active process that takes time

3.3.2. Learning involves cognitve self-instruction, assisted learning, and the zone of proximal development

3.3.3. Senior learner provides support to the learner to allow them to eventually solve problems, then withdraws coaching as the student gains independence

3.4. Role of the Student

3.4.1. Responsible for learning by communicating and collaborating with others; sharing, reflection, and questioning ways to learn from others

3.4.2. Needs to have dialogue on how the learning relates to real-life situations and reflect on meaning of the content and the learning process to extend their learning

3.5. Role of the Educator

3.5.1. Must understand what the learner has mastered and what comes next

3.5.2. Provide "scaffolding" support while the student is learning and then trust them enough to withdraw the support as the student demonstrates mastery

3.6. How this theory informs my instruction for MTP

3.6.1. It is important that the educator scaffold or build on tasks that the learner has already learned, such as a basic blood transfusion and independent double checks. Having all nurses view videos with real-life case scenarios and troubleshooting for each skill of the MTP with questions they must answer after each could help the student put it all together. Then the team could collaborate on a simulation, first with more experienced nurses supporting them. Then perform the same scenario, giving more complex skills to the newer nurses, to perform on their own. Debriefing afterward to discuss what their strengths and weaknesses were and what it meant for the patient's outcomes could help build them further.

4. Social Learning Theory

4.1. Theorist

4.1.1. Albert Bandura

4.2. View of Knowledge

4.2.1. Mental states matters; attention and self-regulation of behaviors is key

4.2.2. People learn through observation and modeling of others

4.3. View of Learning

4.3.1. Goal of learning is to develop self-efficacy; High efficacy will lead to ability to perform more complex tasks and build confidence

4.3.2. Learning is best able to occur when accompanied by social interaction, learning through observation

4.4. Role of the Student

4.4.1. Must pay attention, self-regulate behavior, store info for later use, observe, stay motivated, and be honest with self

4.4.2. Need to build self-efficacy by using past experiences, feedback from others, vicariously modeling others performing the tasks, and judge self honestly based off of other's mastery

4.5. Role of the Educator

4.5.1. Emphasize self-efficacy using role-playing, simulation, and clinical experiences that develop student's self-efficacy

4.5.2. Create a trusting, encouraging environment for learners, use peer to peer teaching or near-peer mentors, and praise learner's accomplishments

4.6. How this theory informs my instruction of MTP.

4.6.1. Building self-efficacy for the student to grasp and become competent in Massive Transfusion Protocol, the educator can create a simulation that allows newer nurses to start with the easier skills, such as calling for, obtaining the MTP, and performing the independent double check of blood, and then have the more experienced nurses, or near-peers, to demonstrate the more complex skills like using the rapid transfuser and administering the anticoagulants ordered. The team can then debrief and review the strengths and weaknesses and change roles for the next simulation of the same process, allowing the newer nurses to perform the more complex skills.