Journal of Nursing Education

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Syllabus Selections: Innovative Learning Activities 

Safe Blood Administration Learning Activity

Barbara Carignan, MSN; Caryn Sheehan, DNP

Abstract

In a single year, nearly 5 million Americans need blood transfusions, 92.7% of which are administered by nurses (National Heart, Lung, and Blood Institute, 2007; Novis, Miller, Howanitz, Renner, & Walsh, 2003). Human error is often cited as the most common cause of adverse effects from blood transfusions (Dzik, 2007).

In an era of emerging technology and bar coding systems, it is important that nurses do not bypass necessary checks and basic safety measures. An observational audit of 12,448 blood transfusions by Novis et al. (2003) found proper identification procedures were fully completed only 62.3% of the time and post blood administration monitoring occurred only 81.6% of the time.

A learning activity for nursing students was designed to facilitate active learning about the procedure for safe blood administration. The teaching method includes activities that are effective by auditory, visual, kinetic, and observational learners. The objectives of this activity are for students to:

The teaching session begins with a 10-minute review of blood type matching through a competitive game of giant paper dice. The dice are easily handmade and taped together using copier paper.

The activity is designed to be used in a group, with group size limited only by how many students can fit around a large conference room table. A group of 6 to 10 students is ideal.

The group is divided into two teams. Each team receives two dice. One die has the various blood types on each side (A, B, AB, O), and the other die has Rh+ and Rh– written on three sides each.

One team then becomes the blood donor, and the other team is the recipient. The two teams roll the dice and decide together whether the blood types and Rh factors are a compatible match. If the blood types of the two teams do not match, the donor team receives an award; however, if the blood types do match, then the recipient team receives an award.

In the second half of the blood transfusion activity, students are grouped in pairs, with one student acting as the patient and the other student acting as the nurse. Students serving as patients wear paper blood transfusion bracelets on their wrists and are given a list of signs and symptoms of transfusion reactions to act out. Students can be assigned patient names of pop culture personalities such as Big Bird and Beyonce to keep their interest.

The students serving as nurses are given blood packs (i.e., juice boxes) and are required to complete all of the necessary checks (right patient, right time, right route, right dose, matching transfusion numbers, matching blood types) prior to administering the blood. The nurses also are responsible for finding a second nurse to serve as a witness according to the hospital policy. Nurses then sit with their patients for an abbreviated 15 minutes and are instructed to document any signs and symptoms that may be indicative of a blood transfusion reaction. Once finished, the nurses then share their observations with the rest of the group.

During this interactive teaching strategy, students verbalized and demonstrated the checks and documentation required when administering blood. Students stated they felt confident in being able to identify the signs or symptoms of blood transfusion reactions.

Overall, the students enjoyed the inclusive and lively design of the lesson. One student commented, When we were doing the activity, we did not even realize how much we were learning. I was just having a good time acting out what John Lennon would be like if he was itching all over.

At the end of a busy clinical day, this 20-minute…

Safe Blood Administration Learning Activity

In a single year, nearly 5 million Americans need blood transfusions, 92.7% of which are administered by nurses (National Heart, Lung, and Blood Institute, 2007; Novis, Miller, Howanitz, Renner, & Walsh, 2003). Human error is often cited as the most common cause of adverse effects from blood transfusions (Dzik, 2007).

In an era of emerging technology and bar coding systems, it is important that nurses do not bypass necessary checks and basic safety measures. An observational audit of 12,448 blood transfusions by Novis et al. (2003) found proper identification procedures were fully completed only 62.3% of the time and post blood administration monitoring occurred only 81.6% of the time.

Objectives

A learning activity for nursing students was designed to facilitate active learning about the procedure for safe blood administration. The teaching method includes activities that are effective by auditory, visual, kinetic, and observational learners. The objectives of this activity are for students to:

  • Verbalize knowledge of blood type matching.
  • Demonstrate the ability to perform the required checks prior to blood administration.
  • Identify the signs and symptoms of transfusion reactions.

Interactive Learning Activity

The teaching session begins with a 10-minute review of blood type matching through a competitive game of giant paper dice. The dice are easily handmade and taped together using copier paper.

The activity is designed to be used in a group, with group size limited only by how many students can fit around a large conference room table. A group of 6 to 10 students is ideal.

The group is divided into two teams. Each team receives two dice. One die has the various blood types on each side (A, B, AB, O), and the other die has Rh+ and Rh– written on three sides each.

One team then becomes the blood donor, and the other team is the recipient. The two teams roll the dice and decide together whether the blood types and Rh factors are a compatible match. If the blood types of the two teams do not match, the donor team receives an award; however, if the blood types do match, then the recipient team receives an award.

In the second half of the blood transfusion activity, students are grouped in pairs, with one student acting as the patient and the other student acting as the nurse. Students serving as patients wear paper blood transfusion bracelets on their wrists and are given a list of signs and symptoms of transfusion reactions to act out. Students can be assigned patient names of pop culture personalities such as Big Bird and Beyonce to keep their interest.

The students serving as nurses are given blood packs (i.e., juice boxes) and are required to complete all of the necessary checks (right patient, right time, right route, right dose, matching transfusion numbers, matching blood types) prior to administering the blood. The nurses also are responsible for finding a second nurse to serve as a witness according to the hospital policy. Nurses then sit with their patients for an abbreviated 15 minutes and are instructed to document any signs and symptoms that may be indicative of a blood transfusion reaction. Once finished, the nurses then share their observations with the rest of the group.

Students’ Responses

During this interactive teaching strategy, students verbalized and demonstrated the checks and documentation required when administering blood. Students stated they felt confident in being able to identify the signs or symptoms of blood transfusion reactions.

Overall, the students enjoyed the inclusive and lively design of the lesson. One student commented, When we were doing the activity, we did not even realize how much we were learning. I was just having a good time acting out what John Lennon would be like if he was itching all over.

At the end of a busy clinical day, this 20-minute interactive teaching session afforded students the opportunity to learn about the safe administration of blood, while keeping the students actively engaged.

References

  • Dzik, W.H. (2007). New technology for transfusion safety. British Journal of Haematology, 136, 181-190.
  • National Heart, Lung, and Blood Institute. (2007). Who needs a blood transfusion? Retrieved January 28, 2008, from http://www.nhlbi.nih.gov/health/dci/Diseases/bt/bt_whoneeds.html
  • Novis, D.A., Miller, K.A., Howanitz, P.J., Renner, S.W., & Walsh, M.K. (2003). Audit of transfusion procedures in 660 hospitals: A College of American Pathologists Q-Probes study of patient identification and vital sign monitoring frequencies in 16,494 transfusions. Archives of Pathology & Laboratory Medicine, 127, 541-548.
Authors

Barbara Carignan, MSN
University of New Hampshire
Caryn Sheehan, DNP
CSheehan@anselm.edu
Saint Anselm College

10.3928/01484834-20100218-04

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