Professional Portfolio - Comeau, Nick

Nicholas P. Comeau





BSN, RN, CCRN, TCRN, CPN






Master of Science in Nursing Candidate

Nursing Education and Faculty Role
College of Nursing and Health Professions

Drexel University
Philadelphia, PA

Biography



Philosophy of Teaching

Nicholas Comeau (Nick), originally from Fairhaven, Massachusetts,
currently resides in Winston-Salem, North Carolina. Nick completed
his undergraduate education and training at the Massachusetts
College of Pharmacy and Health Sciences (MCPHS) in Boston,
Massachusetts. Currently, he is in the final quarters of his Master of
Science in Nursing – Education program at Drexel University in
Philadelphia, PA. He currently holds the position of Interim Nurse
Manager for Pediatric Critical Care at Brenner Children’s Hospital.
Nick currently holds active board certifications in Pediatric Critical
Care (CCRN), Trauma (TCRN), and general pediatrics (CPN). In
addition to his current role at Brenner, he is an active advanced life
support instructor for the American Heart Association in Advanced
Biography Cardiovascular Life Support (ACLS) and Pediatric Advanced Life
Support (PALS). He is an active member of the Sigma Theta Tau
International Honor Society of Nursing in the Chi Theta (MCPHS) and

Nu Eta Chapters (Drexel University). Nick holds an active adjunct
faculty position at Forsyth Technical Community College in Winston-
Salem, NC in the Paul M. Wiles School of Nursing in the ADN program.
He is nationally published on the topic pediatric burn sepsis and will
lecture nationally at AACN’s NTI 2018 in Boston, MA on the topic as
well. His clinical interests include pediatric resuscitation, pediatric
burn and trauma, pediatric organ donation management, and
pediatric sepsis. Education interests include in-situ simulations,
professional continuing education, and bridging the new graduate
nurse to professional practice.

§ The progressivism ideology focuses on the future but presents real
world problems in a safe environment of learning that will allow for
critical thinking and analysis to develop solutions and intervention
plans. This takes on the student holistically.


§ Person and the Environment: Each person is a complex individual that
must be viewed holistically who has the ability for rationalized thinking,
self-actualization, and development. Each person comes with both
strengths and weaknesses and often need support and guidance to
overcome and manage their limitations and be valued and respected
though the whole process. Each person entering the environment will
Philosophy of have access to all necessary tools and resources to maximize the well-
being of its members.

Teaching § Learning and Teaching: Growth is not viewed as a linear progression

but rather fluctuations. The development of abstract thought occurs
through the learner becoming familiar and oriented to relativism.

§ Educator and Student: The growth of students should be at the center
of the activities of education and not the topic or subject being

presented at that time. The students’ education should be looked more
as a development as a lifelong process of learning rather than subject
mastery. The interactions and relationships between the educator and
the student should actively engage the development of mental,
emotional, physical, spiritual, social, and cultural capacities. The role of
the educator should be to facilitate the development of the whole
person Learning activities challenge the learner to develop decision
making, problem solving, alternative thinking processes, and reflection.

Higher Education



Professional Education

Bachelor of Science in Nursing (BSN)

Massachusetts College of Pharmacy and Health Sciences

Boston, MA
Graduated: May 2013


Education Master of Science in Nursing (MSN) – Education and


Faculty Role

Drexel University

Philadelphia, PA

Expected: May/June 2018

Sigma Theta Tau International Honor Society of Nursing

Member ID: 124431



Chi Theta Chapter

Massachusetts College of Pharmacy and Health Sciences
Inducted: May 2013
Academic Nu Eta Chapter



Honors Drexel University

Inducted: December 2014



School of Nursing Leadership and Professionalism Award

Massachusetts College of Pharmacy and Health Sciences – Boston

Awarded May 2013

Pediatric Care after Resuscitation (PCAR)



TCAR Education Programs



September 2016


New Hyde Park, NY
Professional



Education Trauma Care after Resuscitation (TCAR)





TCAR Education Programs



October 2016


Charlotte, NC

Professional Licenses



Board Certifications

State of North Carolina

Board of Nursing


Registered Nurse

License #: 265660
Professional Multistate Privileges



Licenses Commonwealth of Massachusetts





Board of Registration in Nursing

Registered Nurse


License #: 2286856

Pediatric Nursing Certification Board (PNCB)

Certified Pediatric Nurse (CPN)

Expires: 2/28/2018






American Association of Critical Care Nurses (AACN)
National Board Critical Care Registered Nurse (CCRN) – Pediatric



Certifications Expires: 1/31/2019






Board of Certification in Emergency Nursing (BCEN)

Trauma Certified Registered Nurse (TCRN)

Expires: 11/30/2020

Life Support and



Specialty Certifications

American Heart Association (AHA)


§ Basic Life Support (BLS) Provider

Expires March 2018

§ Pediatric Advanced Life Support (PALS) Instructor
Life Support Expires March 2018



Certifications § Advanced Cardiovascular Life Support (ACLS) Instructor

Expires March 2018




American College of Surgeons (ACS)

§ Basic Bleeding Control (BCon) Instructor

Emergency Nurses Association (ENA)


Trauma Nursing Core Curriculum (TNCC)


§ Expires: September 2018

Emergency and Emergency Nurses Pediatric Course (ENPC)



Trauma § Expires: August 2018



Certifications


International Trauma Life Support (ITLS)



Advanced Provider – Adult

§ Expires: August 2018

Society of Critical Care Medicine
Critical Care Pediatric Fundamentals of Critical Care Support (PFCCS)



Certifications § Expires: 07/15/2021


§ Instructor Candidate

Employment History

Wake Forest Baptist Health


Brenner Children’s Hospital

Medical Center Boulevard


Winston-Salem, NC 27157





Interim Nurse Manager
Current Pediatric Critical Care



Employer and § Provides clinical and administrative leadership for the Pediatric ICU,
Pediatric IMC, Cardiac Acute Care Unit, Pediatric Sedation Service, and
the Pediatric Rapid Response Team.
Position § Responsibilities include accountability for quality and service


excellence, workplace experience, and financial outcomes. This
includes the fostering of a patient centered professional work
environment through the Theory of Human Caring, the nursing process,

staff development, and collaborative team interactions for the
enhancement of quality and safe patient care.

§ Partners with the Director of Nursing to achieve goals to improve quality
and safety in patient care

Forsyth Technical Community College



Paul M. Wiles School of Nursing


2100 Silas Creek Parkway



Winston – Salem, NC 27157




Current Part- Adjunct Faculty - Pediatrics



Time Employer Associate Degree of Nursing Program



and Position Provides students with opportunities to acquire the



knowledge and practice the skills identified in course

objectives using varied and appropriate teaching

methods in clinical setting

AMN Healthcare/NursesRX
Pediatric ICU Travel Nurse

Assignment: University of Virginia Children’s Hospital Pediatric
Cardiac ICU/Pediatric ICU, Charlottesville, Va
12/2016 – 03/2017


Cone Health

Moses H. Cone Memorial Hospital, Greensboro NC
Relief Pediatric ICU Staff Nurse
05/2015 – 06/2016

Past Employers Wake Forest Baptist Health


Brenner Children’s Hospital,Winston Salem, NC
Charge Nurse – Pediatric ICU
02/2016 – 12/2016



Staff Nurse II – Pediatric ICU
11/2014 – 02/2016



Wake Forest Baptist Medical Center, Winston Salem, NC
Staff Nurse – Burn ICU
10/2013 – 11/2014

Professional Publications



and Presentations

Comeau, N. P. (2016, November). Recognition,

Publication management, and prevention of burn sepsis in pediatric


patients. Nursing2017 Critical Care, 11(6), 24-30

May 2018


American Association of Critical Care Nurses
Podium National Teaching Institute and Critical Care Exposition



Presentation Boston, MA

Pediatric Burn Patients in Sepsis

Comeau, Nicholas

April 2018


Wake Forest Baptist Health Nursing Grand Rounds

Winston Salem, NC

“Aye Doc, this Burn Kid doesn’t look too good”: Responding to


Pediatric Burn Patients in Sepsis
Continuing Comeau, Nicholas



Education and


Professional March 2018


Northwest Area Health Education Center (AHEC)
Development Winston Salem, NC



Pediatric Critical Care Registered Nurse (CCRN) Review Course

Lectured Topics: Hematology/Oncology; Pediatric Shock States;


Pediatric Burns and Child Abuse

Comeau, Nicholas

May 2018

American Association of Critical Care Nurses

National Teaching Institute and Critical Care Exposition

Boston, MA


Provisioning Bedside Patient Safety through

Standardization of Pre-Shift Safety Checklists

Comeau, Nicholas; Beck, Lauren
Posters




September 2015

Boston Children’s Hospital

Connect Share Impact: Pediatric and Neonatal Critical


Care Nursing Summit

Recognition, Management and Prevention of Burn Sepsis

in Pediatric Burn Critical Care Patients

Provisioning Bedside Patient Safety through Standardization of Pre-Shift Safety
Checklists in a Multidisciplinary Pediatric Intensive Care Unit
Nicholas P. Comeau, BSN, RN, CCRN, TCRN, CPN; Lauren M. Beck, BSN, RN, CCRN, TCRN, CPN
Pediatric Critical Care – Pediatric Intensive Care Unit
Wake Forest Baptist Health – Brenner Children’s Hospital, Winston-Salem, NC, USA



Overview Implementation Process Checklist Parameters
• The goal of this project was to standardize pre-shift safety • The checklist was developed and implemented by identifying actual and Parameter Anticipated Findings Total Incidents Reported
handoff between the oncoming and off-going nurses to potential pitfalls in bedside safety at change of shift. dosing weight matches the current weight in Pre Checklist Implementation vs. Post Checklist
Implementation
provision the highest level of patient safety in multi-specialty • A implementation team was formed of beside staff nurses, clinical Appropriate Dosing Weight EMR
105
Pediatric Intensive Care Unit at a large academic children’s leadership, and the PICU medical director to allow for a multidisciplinary • airway signage is in place if patient is an
hospital. approach. Airway airway alert or critical airway.
• The implementation of a standardized communication tool • It was important for the checklist to foster simplicity but achieve the goal of • airway is secured and not at risk for
allowed for the reduction of misinformation or omission. provisioning safety in different identified areas from apparent cause dislodgement. 100
• It provides comprehensive evaluation of needs of a safe ICU analyses and incident reports. Medication Sheet Present at bedside and appropriate dosing
weight
environment for the patient.
• The overall goal of the implementation and utilization of this Figure 1: Implementation Plan • all suction regulators and tubing 95
functional.
checklist was to mitigate errors related to impaired • If patient is intubated, inline suction is
provisioning of bedside safety and lack of standardized Suction Set-Up and functional and the valve is turned off
Functionality
communication behaviors when not in use. 90
• Yankauer is readily accessible and
Literature Review attached to the suction tubing.
• Access sites free from signs of infiltration
• Breakdowns in communication are estimated to contribute to or other concerns of dislodgement 85
80% of all medical errors(Jewell, 2016) Access • dressings are clean, dry, and intact
• Roadblocks become direct causes of adverse safety events
(Vergales, et al., 2014) all drugs, concentrations, administration 80 October 2016 - March 2017 (Pre April 2017 - September 2017 (Post
• Miscommunication Medication Infusion dosage, and flow/infusion rate for all Total Incidents Reported Per 6 Implementation) Implementation)
continuous infusions with infusion pump and
Verification
• Disorganization posted orders Months 102 89
• Inadequacy of Reporting of Information • all drains and tubes are secured to avoid
• Structured and standardized communication allows for more accidental dislodgement. Data Interpretation and Analysis
streamlined communication to allow for better provisioning of Drains • All drains empty and output verified. • More utilization of the checklist resulted in more safety incidents being
safety (Jewell, 2016). • Ensure proper settings on all drains discovered.
• The utilization of structured handoff tools for children admitted alarm limits and parameters are within age • Total amount of safety events discovered fluctuated month to month but
to the ICU is feasible and well received by staff (Carroll, Sala, Monitor Parameters appropriate limits and appropriate for this overall effect on the number of incidents reported decreased.
patient
Benin, 2013). • 10% Reduction of total safety events between pre-implementation and
• Standardizing processes and eliminating random variation post-implementation
allows to the analysis of which changes in care result in Total Completed Checklists vs. Total Incidents • Overall, total amount of safety events are reducing as continued
improved outcomes for patients (Rice & Nelson, 2005). Reported utilization of the checklist remains.
• Streamlined systems of safety communication requires 300
education and commitment of execution to every patient and References
family encounter (Rice & Nelson, 2005). • Carroll, C., Sala, K., & Benin, A. (2013, October). Promoting a culture of
• Difficulty in establishment of standardized handoff 250 safety in the pediatric ICU by improving the quality of postoperative
communication is the lack of evidence-based research that handoffs. Chest, 406A-406B.
identifies a specific methodology, This has led to evolvement 200 • Jewell, J. (2016, November). Standardization of inpatient handoff
of different methodologies that have both strengths and communication. Pediatrics, 5(138), E1-E6.
weaknesses (Keebler et al., 2016) • Keebler, J., Lazzara, E., Patzer, B., Palmer, E., Plummer, J., Smith, D., &
• Implementation of checklists is both effective in organization 150 ... Riss, R. (2016). Meta-analyses of effects of standardized handoff
and preventing the omission of critical information sharing. It protocols on patient, provider, and organizational outcomes. Human
allows for both a set parameter that must be met before Factors: The Journal of Human Factors and Ergonomics Society, 1187-
1205.
advancing and provides simultaneous cross check of 100 • Nemeth, C. (2012). Improving healthcare team communications: Building
parameter (Nemeth, 2012). on lessons from aviation and aerospace. Farnham: Ashgate.
• A well formulated checklist creates a culture of adherence and • Rice, B., & Nelson, C. (2005, December). Safety in the pediatric ICU: The
50
reduction of memory reliance (Vergales et al., 2014) key to quality outcomes. Crtical Care Nurse Clinics of North America, 431-
440.
0 • Vergales, J., Addison, N., Vendittelli, A., Nicholson, E., Carver, J.,
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Stemland, C. .., & Gangemi, J. (2014, January 17). Face-to-face handoff:
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17
Completed Checklists 113 131 82 81 87 99 264 165 211 Improving transfer to the pediatric intensive care unit after cardiac surgery.
Incidents Reported 18 23 10 9 12 17 4 21 14 American Journal of Medical Quality, 119-125.

Work in Progress

Application of the Theory of Situated Learning to the Care and
Management of Pediatric Sepsis in the Pediatric Intensive Care Unit

Nicholas P. Comeau, BSN, RN, CCRN, TCRN, CPN
Drexel University



Abstract Teaching Strategies
The recognition, care and management of the pediatric patient in septic Role Play Algorithms
shock is multifaceted and requires the registered nurse to be highly skilled Description: Role play allows for a dramatic perspective in which individuals Description: foster a step-by-step approach for clinical decision making based
and knowledgeable to quickly recognize, intervene, and stabilize the patient assume the roles of others and are observed by others (peer learners or on evidence-based research and practices. Allows for content mastery
for ongoing management and support in the pediatric intensive care unit faculty) for attainment of learning outcomes through analysis and through rule-based problem solving or by concrete content stages (Phillips,
(PICU). Priorities of care in the pediatric septic shock patient include interpretation. Reams and Bashford assert that structured experiences in role 2016, p. 252).
provisioning the ABCs of Life which include the airway, breathing, and play allow for the facilitation of reorganization of the learning concepts by the Goal of Teaching Strategy: The learner is able to develop knowledge and
circulation. It is vital that the registered nurse provisions a patent airway, learner to produce greater meaning and understanding (Reams & Bashford, criteria to aid in drawing out the most relevant information to aid in the
institutes rapid assessment and intervention for ineffective breathing and 2011). development of complex problem solving abilities (Phillips, 2016, p. 252)..
ventilation, and promotes circulation through provisioning patent intravenous Goal of Teaching Strategy: The goal of the implementation of role play is to Application to Pediatric Sepsis: Utilization of an algorithm in conjunction
or intraosseous access and administering aggressive fluid resuscitation and teach the learner different role perspectives. The learner is then able to have with a case study can allow for a greater degree of enhancement of learning
further support of circulation through vasoactive medications and a greater appreciation of the different roles in the response Reams & and aid in the learner’s overall comprehension and application by reducing
corticosteroid administration for catecholamine resistant shock states. This Figure 1: Novice to Expert Progression Bashford, 2011). complex concepts (Phillips, 2016, p. 252). It will allow the adherence of best
poster will examine the application of the theory of Situated Learning to http://novicetoxpertnursingtheory.blogspot.com/2017/08/theorist-background- Application to Pediatric Sepsis: The registered nurse is assigned the role of safety and quality practices in the care of the pediatric septic shock patient.
teaching registered nurses the knowledge and skills required to care for the study.html the respiratory therapist in the role play by the facilitator, that learner then Implementation of Figure 2 in case studies and simulations will allow for an
pediatric septic patient through innovative teaching strategies to promote Applying the Theory to Pediatric Sepsis has the opportunity to gain a greater understanding of the role and enhanced learning process of the assessment, treatment and ongoing
active learner engagement and positive learning outcomes. • The theory of situated learning typically utilizes complex practice scenarios responsibility of the respiratory therapist in the treatment. This could be management of pediatric sepsis to occur by the learner.
The Theory of Situated Learning to allow the learner to recognize the importance of need for development performed for all different providers that is involved in pediatric sepsis Conclusion
treatment and management including physician, charge nurse, and nursing
• Based off of two main principles of action and improvement plans to better handle similar situations in the assistant. Simulation and role play allow for situated active learning. The
• Knowledge needs to be presented in an authentic context future (Ailey, Lamb, Friese, & Christopher, 2015). implementation of structured case scenarios and algorithms within
(Kearsley, 2015). • provide learning opportunities to assist in skill development focused on Simulation simulations and role plays promote active learning for the learner to gain
• settings and applications that would real-world situations to better allow for the development of collaboration Description: the learner is “directly engaged in the activity and obtain instant valuable opportunities gain a greater knowledge base but also gain an
normally involve that knowledge. and clinical decision making as well as inter-professional communication. feedback and reinforcements of learning” (Jeffries, 2005, p. 98). increased skills set. Active learning strategies that provide prompt feedback
• Learning requires social interaction and collaboration • Learning activities that emphasize: Goal of Teaching Strategy: The learner is able to rationalize and select the about the learner’s performance on a particular situation allow a higher
(Kearsley, 2015). • learner immersion into the situation or scenario to have a appropriate interventions necessary to stabilize and manage the patient. The degree of knowledge acquisition and further guide the learner to a higher
• The major objective is to bring the learner into the “real world” in the higher degree of authentic learning experiences. learner is able to see the impact of their interventions and assessment as the degree of achieving learning outcomes. Situated learning strategies
academic setting to allow the learner to prepare themselves to find their • focus on application to clinical situation and practice rather simulation progresses (Jeffries, 2005, p. 98). potentiates collaborations in learning and knowledge sharing as well as
way through complex and poorly articulated environments which they will than forced knowledge content attainment. Application to Pediatric Sepsis: Simulating pediatric sepsis in a medium or instilling a greater sense of multidisciplinary collegiality and team building to
ultimately be placed in (Candela, 2016, p. 216). high fidelity simulation environment will allow the learner to hone in on provision a learning environment that allows for the attainment of new
• Situated cognition challenges the learner to critically think and analyze specific knowledge, skills, and attitudes that are necessary in the knowledge, skills, and ideas to have the learner go into the real world and
what they know at the present time and what they can perform in a management of the patient. The simulations should be based off of evidence provide the highest degree of quality and safety in care.
particular situation. based practices such as the American Heart Association Pediatric Advanced
• This promotes the learner to comprise knowledge to make Life Support Septic Shock Algorithm. Approaching the simulation from an References
sense of their unique experiences and further develop algorithm-based approach and setting the case scenario up will allow the
inquiry (Bastable & Alt, 2014, p. 445). learner to learn the proper prioritization of care but also since each pediatric Ailey, S., Lamb, K., Friese, T., & Christopher, B.-A. (2015). Educating nursing
• Situational immersion to allow for a greater degree of synthesis of new septic patient is different, this forces the learner to have situational students in clinical leadership. Nursing Management, 23-28.
knowledge and application (Candela, 2016, p. 216). awareness and have a situated learning experience. Babatsikou, F. P., & Georgianni, G. K. (2012). The importance of role-play in
• Social interaction is a critical component nursing practice. Health Science Journal, 4-10.
• learners become involved in a "community of practice" Case Scenarios Bastable, S. B., & Alt, M. F. (2014). Behavioral Objectives. In S. B. Bastable,
which embodies certain beliefs and behaviors to be Nurse as Educator: Principles of Teaching and Learning for Nursing Practice
acquired. Description: allow for the in-depth analysis of a real-life situation as a way to (pp. 423-468). Burlington: Jones & Bartlett Learning.
• require the learner to investigate and collaborate through integrate and apply specific theory and knowledge into practice. Case Candela, L. (2016). Theoretical foundations of teaching and learning. In D. M.
different sources and also participate in group learner scenarios can be applied through simulation, group-based learning, or non- Billings, & J. A. Halstead, Teaching in Nursing: A Guide for Faculty (pp. 211-
reflections to gain greater cognitive gain and attainment of simulated/didactic means. 229). St. Louis: Elsevier.
new knowledge. Goal of Teaching Strategy: The learner is able to comprehend important Davis, A., Carcillo, J., Aneja, R., Deymann, A., Lin, J., Nguyen, T., . . . K, C.
• Novice to Expert Phenomenon outcomes of learning that is critical to real-world situations. This method (2017). The American College of Critical Care Medicine Clinical Practice
• As the beginner develops more knowledge and allows for the learner to draw on previous knowledge and subsequently Parameters for Hemodynamic Support of Pediatric and Neonatal Septic
understanding, they become more active and engaged connect theory and knowledge to practice (Phillips, 2016, pp. 255-256). Shock. Pediatric Critical Care Medicine, 884-890.
within the content and progress towards a content expert Application to Pediatric Sepsis: complex scenarios that require a moderate to Jeffries, P. (2005, March/April). A framework for designing, implementing, and
in knowledge and experience. (Kearsley, 2015). major degree of problem solving (Phillips, 2016, pp. 255-256). evaluating simulations used as teaching strategies in nursing. Nursing
Some examples include: Education Perspectives, 26(2), 96-103.
• Cardiogenic Septic Shock Management (Myocarditis) Kearsley, G. (2015). Situated Learning. Retrieved November 19, 2017, from
• Vasoconstricted Septic Shock States InstructionalDesign.org:
• Vasodilated Septic Shock State http://www.instructionaldesign.org/theories/situated-learning.html
• Catecholamine-Refractory Shock State Phillips, J. M. (2016). Strategies to promote student engagement and active
learning. In D. M. Billings, & J. A. Halstead, Teaching in Nursing: A Guide for
Faculty (pp. 245-262). St. Louis: Elsevier.
Reams, S., & Bashford, C. (2011). Interdisciplinary Role Play: Nursing and
Theater Students Advance Skills in Communication. The Delta Kappa Gamma
Figure 2: Pediatric Septic Shock Algorithm – Society of Critical Care Medicine
Bulletin, 42-48.