NR 621 Week 4 Literature Review Example

Literature Review: Four Approaches to Building Heparin Titration Skill in New Graduate Nurses, Read for Dose, Delivery and When Results Were Measured

Student Name

College of Nursing, Chamberlain University

NR 621: Nurse Educator Concluding Graduate Experience I

Instructor Name

Month Day, Year

Literature Review: Four Approaches to Building Heparin Titration Skill in New Graduate Nurses, Read for Dose, Delivery and When Results Were Measured

How the Review Is Organized

The needs assessment found errors at nomogram selection, rate conversion and pump programming, and a preceptor habit of finishing titrations under pressure. The review is organized around four approaches that might address those findings, rather than around authors.

Approach 1: Simulation With Deliberate Practice and a Mastery Standard

What was tried: learners practice a defined skill repeatedly in a simulated setting, receive feedback after each attempt and continue until they meet a fixed standard.

Who received it and how much: mostly medical residents and students; contact ranged from a single session to several hours.

Who delivered it: trained faculty with checklists.

What could be seen afterward: a meta-analysis found simulation with deliberate practice produced better skill outcomes than traditional clinical teaching across a range of procedures (McGaghie et al., 2011).

When it was measured: in many studies, at the end of the session; in some, weeks later or on real patients. Results measured at the session's end may not last.

Whose learners: physicians in training rather than nurses. The skills studied, such as central line insertion, differ from medication calculation, but the principle of repeated practice to a standard transfers.

Approach 2: Simulation in Nursing Education

What was tried: replacing part of clinical hours with simulation in prelicensure nursing programs.

Dose and delivery: up to half of clinical hours, delivered by trained simulation faculty with structured debriefing.

What could be seen: in a large national study, students with up to 50% of clinical time in high-quality simulation performed as well as those with traditional clinical placements, both at graduation and in their first months of practice (Hayden et al., 2014).

When measured: at graduation and at six weeks, three months and six months into practice.

Whose learners: nursing students, not new graduates; but the follow-up into early practice is close to this project's group.

Approach 3: Independent Double Checks

What was tried: a second nurse independently calculates and verifies a high-alert medication before administration.

Dose and delivery: built into policy rather than taught as a session.

What could be seen: a systematic review found limited evidence that double checking reduces errors, partly because checks are often not truly independent (Alsulami et al., 2013).

When measured: varied; few studies measured actual errors.

Use for the project: the double check is already policy; the review suggests teaching what makes a check independent, such as the second nurse calculating from the original order and weight without seeing the first nurse's figures.

Approach 4: Standardized Protocols and Transition Programs

What was tried: a single weight-based nomogram in place of individualized dosing (Raschke et al., 1993), and structured transition-to-practice programs for new graduates (Spector et al., 2015).

Use for the project: the nomogram is a clinical source; its relevance here is that one standard tool can be practiced to mastery. The transition study supports structured, preceptor-supported practice in the first months.

Teaching Sources Alongside Clinical Ones

Two of the sources are teaching studies; two are clinical or policy. A review drawn only from clinical sources would say what the right dose is but nothing about how to teach nurses to get it right.

What the Sources Say About Dose

Across the sources, skill gains came from repeated attempts with feedback, not from a single exposure. The simulation studies used multiple sessions or many attempts within one session. The project's two 45-minute sessions are short by comparison, which is one reason the standard is set as three consecutive correct attempts rather than a fixed time.

What the Sources Say About Retention

Few sources measured skill months later. The national simulation study followed nurses into practice for six months and found no loss compared with clinical training (Hayden et al., 2014), which is encouraging, but its simulation was far more extensive. The project should therefore check skill again after the sessions, on the unit, through objective 3.

Where the Sources Disagree

The deliberate practice literature emphasizes practice to a standard. The double-check literature questions whether a second nurse adds safety when checks are not independent. Both can be true: individual skill matters most, and a well-taught independent check is a second line of defense, not a substitute.

Search Notes

Two databases, CINAHL and PubMed, were searched for simulation, deliberate practice, mastery learning, medication calculation, heparin and new graduate nurses, from 2005 onward, with older landmark studies added by hand. Twenty-two sources were read in full; the six used here were chosen because they report dose, delivery and timing clearly enough to guide design.

How the Review Will Be Used in the Proposal

Each design choice below can be traced to a named approach above, and no choice depends on one paper alone; a choice backed by just one source is kept small and checked again on the unit, where the learners and the pump are real.

The review supplies three design decisions: repeated practice to a set standard, practice on the actual pump and teaching the independent double check as a skill. It also supplies one caution: that results measured at the end of a session may not last, which is why objective 3 is measured on the unit.

Sources Considered and Not Used

Studies of e-learning modules for medication calculation were considered. Most measured knowledge on a written test, not performance at a pump, and were set aside. Studies of high-fidelity simulation for cardiac arrest were considered and set aside as too different in task.

What the Project Takes

Repeated hands-on practice with the unit's own nomogram and pump, with feedback after each attempt, continued until each new graduate meets a set standard. Teaching what makes a double check independent. Asking preceptors to let new graduates complete titrations on the unit, with the preceptor as the second checker rather than the finisher.

What the project does not take: high-fidelity manikins, which are not needed for a calculation and pump task; and long sessions, since new graduates can leave the floor only briefly.

Limits of the Review

No study found tested this exact approach with new graduates on a cardiac unit. The evidence is drawn from related learners and tasks and is used to choose a design, not to predict an effect.

References

Alsulami, Z., Conroy, S., & Choonara, I. (2013). Double checking the administration of medicines: What is the evidence? A systematic review. Archives of Disease in Childhood, 97(9), 833-837. https://doi.org/10.1136/archdischild-2011-301093

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2 Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4

McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706-711. https://doi.org/10.1097/ACM.0b013e318217e119

Raschke, R. A., Reilly, B. M., Guidry, J. R., Fontana, J. R., & Srinivas, S. (1993). The weight-based heparin dosing nomogram compared with a "standard care" nomogram: A randomized controlled trial. Annals of Internal Medicine, 119(9), 874-881. https://doi.org/10.7326/0003-4819-119-9-199311010-00002

Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38. https://doi.org/10.1016/S2155-8256(15)30031-4