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Management of Vascular Access for Hemodialysis Nurses: A Self-Directed Learning Package

Aim and Objectives

Essentially learning can also be occurred without an educator, however it is more enriched by assistance of an educator or a facilitator (Bastable, 2008 p.76). As mentioned in Noone (2009), the designing process of teaching is a deliberate process that reflects the desired learning results and outcome of the learner. The education takes place in different modes and styles depending on the learners’ needs, upon reflecting on hemodialysis and its procedure, it is defined as life-sustaining treatment procedure for individuals with End Stage Renal Failure (ESRD). For these patients receiving treatment they are dependent on their vascular access which is at good functioning and reliable (Vale, Lopez-vargas, & Polkinghorne, 2012). The vascular access should enables effective therapy delivered to the patients by removal and returning of blood through extracorporeal circuit. Entire treatment of hemodialysis is dependent on quality vascular access. Mainly there two access that usually being used that is, Arterio-Venous Fistula (AV fistula) and Arterio-Venous (AV graft). The other access through blood stream is Central Venous Catheters (CVC). It is recommended that proper assessment is necessary before cannulation of AVF and AVG (Vale et al., 2012). This is fundamental part that nurses working in the dialysis units should have adequate knowledge and skills when attempting vascular accesses.

First of all, learning package will be commenced with general introduction along with self-directed learning and learning theory. Followed by this topic will be defined briefly, Management of Vascular Access for Hemodialysis Nurses. In addition to this, identification of appropriate content will be conversed as Units, from 1 -5 will be based on two type of Arterio-Venous (AV) accesses and related subjects including central venous catheters (CVC). Followed by this objectives of the content to be delivered will be included. Furthermore, proposed methods, strategies will be discussed, finally, proposed evolution plans will be conversed along with a conclusion.

The aim of this learning package is to educate regarding management of vascular accesses to registered nurses, by assisting to develop competent quality care to hemodialysis patients through self-directed learning module.

Upon completion of all the components in the learning package learners should be able to:

1. Identify the types of vascular accesses

2. Recognize the maturation period for AV access

3. Understand the indication of AV cannulation

4. Identify the factors considered cannulation the AV access

5. Identify potential complications associated with vascular accesses

Targeted audience 

This learning package is designed to impart knowledge for the newly joined nurses and currently working nurses of Hemodialysis centers. By help of this package nurses can increase their competency levels and provide quality care to the patients. Every nurses who making use of this learning package is accountable for evaluating the appropriateness before apply this into their practice. Moreover any nurse who is interested in AV accesses can make use of this learning package.

Outline of the Learning Package

This learning package is intended to focus on deliver knowledge to any Hemodialysis care settings. This training module intend and designed to deliver information to nurses preparing them for clinical settings to enhance their skills and knowledge, in more relevant and useful and interesting to the learners. The main resources assists in learning this package includes, using information technology, internet access for skillful application of knowledge of the learners. Well-functioning vascular access allows and effective and efficient hemodialysis treatment. This learning package will be based on overview of the anatomy, access monitoring, cannulation methods and complications of vascular accesses. The self-assessment component at the end of each topic will keep the learner engaged all through the learning package.

The timing to achieve the intended objectives of this learning package is 16 hours including brainstorming and evaluation.

Evaluation helps to identify the learners’ achievement in delivered content (Bastable. 2018). Ongoing evaluation will be held throughout the learning package, this will identify the effectiveness of the educational package and intensity of application of the knowledge. Evaluation will be related to the proposed objectives of the units described below. As mentioned by Bastable (2018) intermittent evaluation of the learners helps to identify whether learning process is going as planned by the educator. Effectiveness of the entire learning package can be identified through a small survey amongst the learners who attempts to read this learning package.

Tekkol & Demirel, (2018) described self-directed learning as an individual’s learning experience in control of planning, continuing, and evaluation. Self-directed learning takes place in number of expects that is, empowered learning, learning effort that is more responsible, individualities in learning process, and it is believed learning in isolation is not necessary (Hiemstra, 1994). In addition to this, this type of learning is presented in both skills and knowledge wise, and more towards self-directed, guided, by options taken by each individual, more open in learning, towards non-traditional course, and also in innovative learning (Hiemstra, 1994). In overall background of adult learning is covered (Abdullah, 2001). In terms of learning, learning in self-directed are controlled by individuals determination towards learning which has more options and dimensions towards the achievable direction  (Abdullah, 2001). One of the main benefits of adult learning in self-directed learning is students are encouraged to improve their own way of learning by improving leadership skills  (Bolhuis, 1996). Taylor (1995) found that this learning tyoe makes students more motivated, self-disciplined, independent, confident and goal-oriented. In the same manner, self-direct learning identifies its external as primary responsibility of individuals and accountability as internal factor in relation to thought and skills.

Learning Environment and Resources

Spencer & Jordan (1999) as cited in (Tekkol & Demirel, 2018) individuals are formulated for lifelong in self-directed learning. Furthermore, these learners prepares them self for more personal and professional aspects even after university and they have ability to sustain this by persistent learning, that is how they become lifelong independent learners (Tekkol & Demirel, 2018). Most of the literatures emphasize there is a link between higher level of thinking skills, critical thinking, creativity and problem skills. In addition to this, academic success of the self-directed learners are more (Tekkol & Demirel, 2018). Furthermore, if an educator emphasizes on self-directed learning, educator must prepare themselves in preoccupation with tracing and fixing mistakes, a practice that is self-esteem threatening (Abdullah, 2001). In addition to this, teacher should establish self-monitoring habit and encourage learners on what they prepared and to revise attempted work (Abdullah, 2001). However, Hiemstra, (1994) challenged the assumption that these learning is only possible by help of teachers, moreover he emphasized people to carry learning outside the training organizations and meet the challenges of self-directed learning by keeping with constantly changing knowledge.

Bastable (2008), define learning theory as combined framework that consists of principles that forecast, explain and describe how people behave in learning. An interesting belief about learning is that if a person is enriched with knowledge there is high chance that person actively involves in practically. The art adult teaching requires effective application of theories in adult learning that also requires a tireless efforts to show this on their practical environment (Herod, 2003). 

Malcolm Knowles is the person who found the andragogy adult learning theory, he describe it as an art that helps adults t acquire knowledge. Knowles this theory helps people to identify, learners by actively engaging them in educational concept (Corley, 2011)

This theory was found in 1968, several educators construct their learning concept on basis of andragogy theory (Herod, 2003). Merriam (2001) as cited in (Herod, 2005) viewed andragogy theory as Knowles perceived, this theory is less of a theory but rather assumptions that incorporates and serves in other theory that emerges along with this theory. There are principles discussed by Knowles regarding andragogy theory, about how educators should reflect this theory in their teaching (Corley, 2011), this includes:

1. The content and process of the learning should be related to adults’ role as self-directed learners .


2. As adults are experienced person rather than children, they should related the knowledge they already have with the current learning environment.]


3. Since most adult learning theories are based on formulated principles, the conveyed content should have relation with their personal life as well.


4. Problem solving should be given more importance than memorizing the content.

A. In addition to this, Knowles andragogy formulated five rules that educators should focus on while planning learning sessions for adult learners (Corley, 2011). That is, self-concept, past experience of the adults, readiness in learning, present their own practical reason in learning since adults may be on continuous education plan, and internal  motivation should be there to learn on new fields (Corley, 2011).  

B. The main purpose of using Malcolm Knowles andragogy theory in this learning package is, since this learning package is directed to impart knowledge for the newly joined nurses of Hemodialysis center and enrich the knowledge in currently working nurses. Meanwhile these nurses already have background knowledge and skills related to concept, however the content and area is different.

C. Therefore according to the theory described above, adult learning is believed to be most effective to teach the target group. As mentioned above instead of memorizing the content learning should be addressed in solving problems, learners should have full potential and self-directed through individualized study options.

D. Most importantly should be motivated and interested in what they are intended to do. According to self-concept learners should focus on past learning experience, create readiness to learn, prepare for practical reasons to learn since many will turn on continuing education when they have reason to learn when entering new field and should be driven by internal motivation.

E. Since this learning package is self-directed and facilitated learning, it openly interrelated the concept of theory mentioned above. This learning package is targeted as mentioned about, to impart knowledge for the newly joined nurses of Hemodialysis center and enrich the knowledge of currently working nurses.

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