A Mixed Pedagogy in Educating Acute Care Nurse Practitioner Students on Paroxysmal Sympathetic Hyperactivity

Abstract

Purpose: The purpose of this quality improvement (QI) project was to develop an activity to address paroxysmal sympathetic hyperactivity (PSH), a sequela of traumatic and acquired brain injury (TBI/ABI), and evaluate pre-/post-activity knowledge and comfort levels. Participants were also asked to approximate intent to change future practice and helpfulness of the activity’s pedagogies.Background: Of 58,600 patients seen in designated Arizona trauma centers in 2020, over 30% were noted to have a component of head/brain injury. Highest mortality patients were those with a Glasgow Coma Scale (GCS) score of 9 or below (47.4%) and those from 15 to 34 years old (47%). These variables are associated with the development of PSH. The absence of radiographic/laboratory testing obscures the diagnosis; providers should be aware of PSH to reduce morbidity/mortality and healthcare cost. Methods: Participants were sought from a cohort of Adult Gerontology Acute Care Nurse Practitioner (AGACNP) students enrolled at the University of Arizona’s College of Nursing. Participants were recruited via email to attend a brief mixed pedagogic activity. Students worked through a PSH case study with multidisciplinary roleplay and were provided a mnemonic. A survey was administered through Google Forms using 7-point Likert scales and open-entry responses to evaluate variables of perceived knowledge and comfort levels, intent to change practice, and pedagogy helpfulness. Quantitative data was analyzed in Microsoft Excel while qualitative data was analyzed for thematic trends. Results: Four surveys were found acceptable for inclusion. The mean pre-activity knowledge and comfort levels were 1.5. Post-activity, the mean knowledge score was 4.5 and the mean comfort score was 4.25. The mean intent to change practice score was 5.75. The mnemonic device was most helpful with a mean score of 4.5, while roleplay achieved a mean score of 4 and the case study a mean score of 3.5. Thematic elements provided insight on the case study, diagnostic considerations/challenges on PSH, and time limitation. Conclusions: The activity was successful in increasing knowledge and comfort levels. An above-median intent to change future practice was noted. Two of the three pedagogic methods were received as helpful. Identified themes are useful in developing future iterations.