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Custom Differential Grading Training essay paper sample

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Expected Entry-Level Knowledge and Skill Background

They should have knowledge on: hematological terms that is Pasophilic Stippling, Hypochromia, Poikilocytosis, Poychromasia, Microcytosis, Macrocytosis, and Howell Jowell bodies; knowledge on hematological indices; ability to perform the objective portion and of the differential, and correctly identify normal and abnormal white blood cells. They should be able to use a microscope and clean it after use, knowledge and skill for making a slide for differentials and ability to stain a slide correctly. They should have previous computer knowledge for use in performing differentials knowledge of the hematology, label slide before staining, clean and file slides after use, pathology criteria and where to file slides. They need further review key boarding skills, college level reading skills, and basic math skills of addition and subtraction

Previous Training Related To This Training

They should have competency on information where by they can use a computer to process information, interprets, and communicates information effectively. Technology prowess s also crucial whereby they can they can apply it to the task and can identify and solve problems with equipment.

Average Reading Level

They should complete a year’s internship in an accredited hospital to be able to be licensed with the state of Florida and the American society of Clinical Pathologists (A.S.C.P.) during their internship; they should have a 4 to 6 week rotation in hematology. They all read at the college level and have perfect command of the English language.

Language or cultural differences among trainees

Five of these trainees are bilingual and can speak and write Spanish with equal proficiency. There are four African-Americans, five Hispanics and is Caucasians. They were trained and undertook their internships in American hospitals.

Trainee Motivation and Job Satisfaction

They indicated that they are satisfied with their salaries, working environment and their co-workers. This provided them with motivation that is required of good results from a job.

Attitude toward Training

They consider the training program as a means of improving their abilities in areas that need it. Their attitude towards training is that it is a mixed blessing. They want the training since it will improve their confidence in grading the subjective areas of the differentials.

Special physical characteristics of trainees relevant to training

Trainees are not expected to harbor any specific physical characteristics but indeed, since this is wound care training, a trainee with a wound may be used for exemplification. However, since the training will occur during the day shift the evening and night employees were not pleased with this change in their schedule.

Special Interests of Trainees Relevant To Training

They all care about the patients and they want to report out the most accurate results. Four of the trainees have a special interest in photography, and this has enhanced their ability to see details.

Biases of Trainees Relevant To Training

The only biases that may prevail are in terms of academic and professional qualification and no other means or form of biases towards trainees. Since these trainees have all entered this program because they were grading differentials incorrectly and /or inconsistently, they will be biased in their performance. The training program has been designed as a 4-week program to overcome these performance biases.

Computer Skills and Confidence

They are also lacking in confidence in the grading of differentials because they do not have a standard procedure to follow when doing the differentials. This is the reason why their differential results are inconsistent. However, they are confident of their computer skills since they have used these skills in the other departments of the laboratory. Some of these trainees have been using the computer for several years while others have only recent knowledge. All the trainees have used our computer system for at least a year. The computer skill involved in doing the grading part of the differential is slightly different but the technologists/technicians have been using the differential program without errors for a year. It is the aim of this program to correct their way of performing differentials, improve their skills, enhance their eye for details and enable them to consistently report out correct results.

Context Analysis

There are currently three hematology specialists in the hematology on the day shift. Two of these technologists have had extensive training experience in orienting new employees and teaching students from the neighboring university during their internship experience. They will both function as trainers and rotate every two weeks. The hematology supervisor will act as bench tech to accommodate the workflow in the hematology department. Since the hematology students have completed their rotation and the next rotation is not due for another 4 months, these technologists will have the time to be trainers in the program.

Issues Related To Resources

The hematology laboratory has extra microscopes and ample counter space and room to accommodate four personnel at a time. The hospital has allotted funds to hire additional personnel to work the night shift and day shift while their personnel are in training. The hematology supervisor will assist the hematology department when she is needed as a bench technologist. The supervisors will fill in for any unexpected illnesses or emergencies. Day shift personnel and night shift personnel will rotate to accommodate training of evening personnel. Eight technologists/technicians have to be trained from the night shift. This will take approximately eight weeks. The night shift personnel and the day shift personnel will rotate their schedules to accommodate the four trainees on evenings that are enrolled in the program. This will take four weeks. The remaining four weeks will be used to train the remaining three day shift technologists. The total training time to train all the necessary personnel is sixteen weeks. One hematology specialist will train three to four people at a time in the hematology laboratory.

Compatibility of Learning Site

Many unexpected events occur in the laboratory and the way they are handled cannot be fully appreciated in a simulated environment. Cold agglutinins, cryoglobulin interference, smudge cells, malarial parasites, are just a few of these surprises. This is the reason that training was chosen for the job site and not a simulated laboratory environment. Cost is also another reason for not choosing a simulated environment. Why would you pay for something that you already possess? The microscopes and the computer differential tool are on-hand. Another reason for not simulating practices was that training time was limited due to cost, personnel involved in the training, and a previous commitment of time to the university students.

Feasibility of Simulating Practice Setting

It will be possible to stimulate the practice setting, but this will certainly not come easily. This will come amidst a lot of cost to cater for the provision, improvisation and transportation of materials, equipment and other resources.

Task Listings for a Given Job - Main Tasks Only

Task Frequency Difficulty Importance

1. Prepare a blood smear on a slide 5 3 5 2. Stain the blood smear. 5 2 5 3. Place the smear on the microscope. 5 1 5 4. Focus the smear on the microscope. 5 2 5 5. Select "dif" on the computer menu. 5 1 3 6. Perform the morphology part of the differential. 5 5 5 7. Verify results. 5 2 2 8. Clean area. 5 1 3 II, III, IV.

Frequency of Task Performance

All the tasks listed have a frequency of five.

Difficulty of Task Performance

Difficulty arises due to inadequate performance of tasks.

Task Importance (Consequence of Inadequate Performance)

Prepare a smear on a slide- If the smear is not prepared correctly, there will be an uneven distribution of cells and you will not find a suitable field for grading cells. 2. Stain the blood smear. If the smear is not allowed to dry properly, watermarks may falsely be reported as hypochromia. If staining does not have the proper buffer morphologic features may be incorrectly identified or not at all. 3. Place the smear on the microscope. If the smear is not dry, you may remove cells. One cannot be able to focus if it is placed up side down. 4. Focus the smear on the microscope. If this is not done properly, you could break the slide or worse you could crack the objective lens. 5.Select “ dif “- If this is not selected, it will increase the time it takes you to perform the job since you will have to manually enter results twice. 6. Perform the morphology part of the differential - if this is not performed adequately, results will be inconsistent and inaccurate and thus will have no meaning. 7. Verify results- If results are not verified, the doctors will not receive the results on their patients and these results will be lost in cyberspace. 8. Clean the area-If this is not performed adequately; eventually oil will corrode the lens and ruin the microscope. If this is not performed adequately, the patients’ slides will be misfiled and not be found for further review by pathology- Loss of time in evaluating the patient.

Condition under Which Task Is Performed

All tasks are performed under different conditions Task 1. Prepare a blood smear Conditions: 2 clean slides held at varying angles dependent on blood thickness. 2. Stain the blood smear Conditions: Stain is prepared fresh daily; Buffer /stain mixture= 6.5 pH 3. Place the smear on the microscope Conditions: Place the dried stained smear only and right side up. 4. Focus the smear on the microscope Conditions: Use coarse adjustment with scan objective only, after a drop of oil change the objective to high/oil, and use fine adjustment. 5. Select “dif” on the computer Conditions: Computer must be on and technologist signed on. 6. Perform the morphology part of the differential Conditions: High/oil field of 200 red blood cells (red blood cells). 7. Verify results Conditions: Accurate results 8. Clean work area Conditions

Cues for Task Initiation and Termination

1. Prepare a blood smear: Begin-After EDTA tube of blood has been mixed End- Successfully preparing a wedge smear and labeling the slide with the patient’s account #. . 2. Stain the smear: Begin -After the smear has dried End-After the stained smear has dried 3. Place the smear on the microscope Begin- when the stained smear has dried End-After, the differential has been completed 4. Focus the smear on the microscope: Begin- when the smear is placed on the stage End – When fine focus causes a clear view under high/oil. 5. Select “dif” on the computer menu: Begin-When the technologist is ready to perform the morphology part of differential. End-After the differential results are verified. 6. Perform the morphology part of the differential: Begin-After the patient account # is entered in the computer. End- When patient morphology is entered and graded. 7. Verify the results Begin- when the patient morphology results are entered End – when screen clears and message says, “Verified” 8.Clean work area Begin. When patient results are verified End - Oil removed from lens and oil-free smear filed

Task Analysis Flow Chart

Function

Task

Sub task

Characteristic Error

1. Prepare a smear on a slide

1.1 Mix blood sample

1.2 Wound dressing

 

1.3 Make a wedge shape smear using two slides.

1.4  Label the smear with patient’s name and Accession

1.5 Let the blood smear stand in the rack until it is dried.

 

 

 

 

2. Stain the blood smear

2.1 Place the dried smear in the staining rack.

 

2.2 Place the staining rack on the stainer. 

2.3 Press the “start” button on the stainer.

 

 

 

3.0 Place the smear on the microscope

3.1 Turn the microscope on

3.2 Place the stained smear right side up on the microscope stage

 

 

4. Focus the smear on the microscope

4.1 Place the scan objective over the smear

 

4.2 Place the high power objective (40 x) over the smear

4.1.1 Looking through the eyepieces, use the coarse adjustment to focus on the smear

4.2.1 Looking through the eyepieces, use the fine adjustment to focus on the smear

 

5 Select “dif” on the computer menu

5.1 Turn the computer on

5.2 “Sign on “ in the computer

 

5.3 Select “dif” from the main menu

5.4 Enter patient’s acc

 

 

5.2.1 Enter name and password at computer prompting

 

6 Perform the morphology part of the differential

6.1 Select a field on the slide where there are 200 red blood cells

6.2 Decide if the morphology is normal or abnormal

6.2.1 If the morphology is normal select normal under “red blood cell morphology”

6.2.2 If the morphology is abnormal identify all abnormal morphology

6.2.2.1 Grade all abnormal morphology

7 Verify Results

7.1 Select “verify” from the menu

7.1.1 Review all results before verifying them

 

8 Clean Work Area

8.1 Place slide face down and blot with paper towel

 

 

 

8.2 On the microscope, wipe oil from the oil objective with lens paper

8.3 Wipe the area with 10% bleach to clean up any blood spills

8.1.1 If slide is normal, file slide in weekly box

 

8.1.2 If slide is abnormal, place slide in pathology review box

 

 

Standards of Task Performance

The smear should cover at least half the length of the slide It should be smooth with no waves, streaks, holes or bubbles. It should end with a feathered edge It should be thin enough to allow proper fixation during staining.

References Utilized In Task Performance

National Committee for Clinical Laboratory Standards (N.C.C.L.S) Naples Community Hospital (NCH) Hematology Laboratory

Tools/Equipment Utilized In Task Performance

Clean slides

Outputs (Results) of Task Performance

A smear with good cell distribution results to accurate and consistent differential results.

Problems that may result from poor task performance and their resolution

Useless smear with uneven cell distribution

Resolution

Prepare a new smear adjusting the angle of the slides. If the smear is too thick, increase the angle. If it is too thin, decrease the angle. If it has waves, streaks or bumps, make sure that the slides are clean and then use an even stroke when pushing the slide. 2. Stain the blood smear Standard.

Human Interfaces during the Task

While performing the tasks in this job, the technologists/ technician works alone and does usually not interact with other technologists, patients, nurses or doctors. The exception to this rule is when an error has occurred. It is at this time that not only is the error corrected in the computer but the Physician. And/or R.N. taking care of the patient must be notified. Another exception to the rule is the technologist observes something unusual in the blood film such as malaria or hemoglobin crystals. These require immediate confirmation and or consultation from either a supervisor or the hematopathologist.

System Interfaces during Task Performance

The computer system used for this job is interfaced with the hospital computer system and all Diagnostic Services satellite hospitals, outpatient service centers and main offices. All the jobs in the laboratory that involve blood or blood products follow universal precautions.

Personnel Safety Considerations

All the jobs in the laboratory that involve blood or blood products follow universal precautions. When performing the tasks in this job of preparing the smear, the technologists must use a safety shield and wear gloves. Counter tops are wiped down with 10% bleach after any bloody procedure as an additional precaution.

Required Skills and Knowledge for Adequate Task Performance

To perform these tasks, the technologist/technician must know the hematology indices and how they are related to size, distribution and color.

Required Skills and Knowledge for Exemplary Task Performance

They must possess basic computer keyboarding skills and know how to use the laboratory-differential menu. They must know the grading criteria and its application in review. They must have basic mathematics skills. They must have basic knowledge of the microscope and its parts. They must have knowledge of hematology terms: Poikilocytosis, Acanthocytes, Spherocytes, Ovalocytes, Schistocytes, target cells tear drop cells, sickle cells, Hypochromia, Macrocytosis, Microcytosis, Polychromasia, basophilic stippling, and Howell Jolly bodies. They must have a minimum of 2 years of college and 1-year internship in the laboratory with a 4- 6-week rotation in the hematology department. They must grade accurately and consistently the morphology area of the differential 90 % of the time. The required skills and knowledge for exemplary task performance are all of the above and the following: The technologists must know the relationship between abnormal morphology and various diseases states. They must also know how to trouble shoot and apply correct resolutions when problems occur. They must grade accurately and consistently the morphology area of the differential 98% of the time. 

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