Forty Nurses and One New Insulin Infusion Protocol: Building Education on Adult Learning Theory, Self-Efficacy and Deliberate Practice Instead of a Slide Deck and a Signature Sheet
[Student Name]
University of Phoenix
DNP/705: Philosophy, Theory, and Science for Nursing Practice
Week 7 Assignment
[Instructor Name]
[Date]
The hospital and scenario are composites written for a model paper.
Our hospital is replacing its paper insulin infusion protocol with a computerized protocol that calculates rate changes from glucose values. Forty nurses in our intensive care and step-down units must learn it in six weeks. The last protocol change was taught with a 30-minute slide presentation and a signature sheet, and a later audit found that 40% of rate changes deviated from the protocol. Insulin infusion errors can cause severe hypoglycemia. This paper designs the education using teaching-learning theory.
Adult Learning Theories
Taylor and Hamdy (2013) review adult learning theories used in health professions education, including andragogy, experiential learning, social learning and self-directed learning, and present a model that combines them into a sequence: a learner's prior knowledge and a trigger for learning, gathering information, making sense of it through discussion and reflection, applying it and receiving feedback, and consolidating. They emphasize that both learner and educator have responsibilities at each stage and that institutions must provide time and resources.
Applying the Adult Learning Model
Our nurses are experienced adults with prior knowledge of insulin drips. The trigger is real: a new protocol they must use next month. Information will come from a short pre-reading and a video of the new screen. Sense-making happens in small groups discussing cases, such as a patient whose glucose falls quickly after a meal tray is removed. Application occurs in simulation. Feedback is immediate. Consolidation occurs through reflection and a follow-up session two weeks after go-live.
Respecting Experience
Adult learners want to know why a change matters and how it relates to what they already do. The sessions begin with our audit data and two anonymized hypoglycemia events, and experienced nurses are invited to compare the new protocol with their current practice. Their expertise becomes part of the teaching, not an obstacle to it.
A signature sheet records that a nurse sat in the room; it does not record whether she can titrate a drip at 3 a.m.
What Went Wrong Last Time
The previous rollout gave nurses information but no chance to use it before caring for real patients. By the adult learning model, the sequence stopped after gathering information, skipping sense-making, application and feedback. The audit's 40% deviation rate is what that gap looks like in practice (Taylor & Hamdy, 2013).
Building Self-Efficacy
Bandura (1977) proposed that self-efficacy, a person's belief in his or her ability to perform a behavior, shapes whether people take on a task, how hard they try and whether they keep going when it gets difficult, and that it derives from four sources: performance accomplishments, vicarious experience, verbal persuasion and emotional arousal. Mastery experiences are the most powerful. Nurses who have successfully titrated a simulated drip through several scenarios will be more confident, and more likely to follow the protocol, than those who only watched a presentation.
Applying the Sources
Performance accomplishment: each nurse completes four simulated scenarios on the actual protocol screen. Vicarious experience: nurse champions from each unit demonstrate a scenario first. Verbal persuasion: facilitators give specific praise for correct decisions. Emotional arousal: scenarios build in difficulty so that nurses succeed early, reducing anxiety about the new system.
Deliberate Practice
Ericsson (2004) reviewed research on expert performance in medicine and related fields and argued that experience alone does not produce expertise; deliberate practice, focused on specific weaknesses, with immediate feedback and repetition, is required to attain and maintain high performance. He found that performance can decline with years of experience when deliberate practice is absent.
Applying Deliberate Practice
Scenarios target the decisions most often done incorrectly in our audit: responding to a falling glucose, handling interrupted nutrition and transitioning to subcutaneous insulin. After each decision, the facilitator gives feedback and the nurse repeats the step until correct. Nurses who make an error repeat a similar scenario before finishing.
Addressing Resistance
Some experienced nurses distrust computerized protocols, preferring their own judgment. Rather than dismiss this, scenarios include a case where the protocol recommends a rate change that seems wrong, and the group discusses when to call the provider. This respects clinical judgment while showing how the protocol handles common situations more consistently than individual estimation.
Learners Who Struggle
Nurses who make repeated errors in simulation receive a second session with a champion, not a warning. Deliberate practice assumes that errors are information for improvement. A nurse who struggles in simulation and practices until competent is safer than one who never had the chance to make an error before touching a patient.
Practical Design
Sessions last 60 minutes, are scheduled on each shift and are paid. Small groups of four allow each nurse to operate the screen. The pre-reading takes 10 minutes. A quick-reference card sits on each infusion pump, and champions are scheduled on every shift during the opening fortnight of the new protocol to answer questions at the bedside.
Timing the Education
Sessions will take place in the three weeks before go-live, close enough that skills are fresh when the protocol starts. Nurses on leave during that period will complete a session in their first week back before caring for a patient on an infusion.
Why Not an Online Module
An online module is cheaper and easier to schedule. But it offers little mastery experience or feedback, the elements Bandura (1977) and Ericsson (2004) identified as most powerful. For a high-risk skill, the cost of face-to-face simulation is justified. The online pre-reading keeps the in-person time focused on practice.
Evaluation
Evaluation will include knowledge on a brief pre- and post-test, confidence on a self-efficacy scale, performance in a final simulated scenario and, most important, practice: the proportion of rate changes that follow the protocol and the frequency of hypoglycemic readings in the first three months, compared with the prior protocol.
Involving the Interprofessional Team
Pharmacists and intensivists join one session per unit to answer questions about when the protocol should be overridden and how to handle orders during transitions. Learning alongside other professions clarifies roles and reduces the calls that interrupt nurses when a protocol step is unclear.
Sustaining Competence
Skills can decay without deliberate practice (Ericsson, 2004), so nurses will repeat one scenario at their annual competency day, and new hires will complete the full simulation during orientation. Audit results will be shared with each unit monthly for the first six months, giving nurses feedback on their collective practice, not only their individual performance in the lab.
Conclusion
A lecture and signature sheet did not change insulin infusion practice last time. This design uses adult learning theory to structure the sequence, Bandura's sources of self-efficacy to build confidence through mastery, and deliberate practice to target the decisions most often done wrong. Evaluation focuses on practice and patient outcomes, not attendance, so the education is judged by what nurses do at the bedside.
References
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191
Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10 Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022
Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561-e1572. https://doi.org/10.3109/0142159X.2013.828153
How this DNP 705 Week 7 example is structured
The DNP/705 Week 7 work usually integrates teaching-learning theory into a practice change. This paper takes a real educational need, selects theories that fit adult clinicians and a high-risk skill and translates each into specific teaching activities and measures. Students search this week as DNP 705 Week 7, DNP705 Wk 7 or DNP/705 Wk 7; all three are the same assignment.
DNP/705 Week 7 questions, answered
What does DNP/705 Week 7 usually ask for?
Many sections ask students to apply teaching-learning theories to a practice change, designing education that fits adult learners and supports lasting change in practice.
What are Bandura's sources of self-efficacy?
Performance accomplishments, or mastery experiences; vicarious experience, from watching others succeed; verbal persuasion; and physiological and emotional states, with mastery experience the most powerful.
What is deliberate practice?
Focused, repeated practice on specific aspects of performance with immediate feedback and opportunities for refinement, which Ericsson argued is essential for developing and maintaining expert performance.
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