Small/Liberal Arts Schools: Saint Mary's College
Public Schools without an AHC: Mennonite College of Nursing at Illinois State University
Academic Health Centers: Medical University of South Carolina
Academic Health Centers: University of Maryland
Private Schools without an AHC: Villanova University
Public Schools without an AHC: James Madison University
Academic Health Centers: University of Cincinnati
Small Schools: Siena Heights University
Private Schools Without an AHC: Pace University
Public Schools Without an AHC: Purdue University
Academic Health Centers: Case Western Reserve University
In the two years that the QSEN Institute has been sponsored by the Frances Payne Bolton School of Nursing, it has served as a catalyst for change in multiple nursing programs and across academic disciplines. Both locally and nationally, the QSEN Institute has provided the resources required to inspire nurse faculty to integrate contemporary quality and safety principles into curriculum and clinical learning to advance professional nursing education. Dissemination of resources has been accomplished through an updated web site and two national forums with over 700 nurses from across the world.
The members of the QSEN Institute at FPB have served as a catalyst for change within the nursing curriculum at both the undergraduate and graduate levels and have impacted the curriculum in the school of medicine and department of public health. The nursing undergraduate curriculum was enhanced to include the QSEN competencies by integrating quality and safety into the majority of the course objectives. Examples include adding quality improvement as a method of inquiry in the undergraduate research course, teaching systems thinking as a way to prevent errors, and teaching teamwork and collaboration through coaching in the leadership course. A shared teamwork language was created so that contemporary team concepts from TEAMStepps would be integrated into all the CWRU health professions programs. This shared language is reinforced during two interprofessional sessions in which over 400 health professions students gather to experience teamwork and collaboration. To date, we have reached over 1600 nursing, medicine, dental, and social work students. Our Masters in Nursing program has been transformed to have Quality and Safety education as its foundation. This year an experiential course on quality improvement was offered and teams of students followed the quality improvement steps to implement real change in their clinical practice sites. Students examined the root causes of why sequential compression devices are not being fully adhered to on six of the University Hospitals of Cleveland clinical units. Change ideas were implemented to increase the use of the devices in order to bring down the incidence of deep vein thrombosis. Next year, a leadership course will be offered that enhances students’ achievement of the QSEN competencies and integrates a quality improvement project.
Faculty use the resources on the QSEN.org website to guide quality and safety into their courses. We have many example of how QSEN influenced our faculty to enhance their courses. One example is Dr. Celeste Alfes, Director of the school’s Learning Resource Center, who integrated QSEN competencies into all the simulation experiences and uses the QSEN competencies to guide student evaluation. Another example was the work of Dr. Margaret Wheatley who partnered with mental health clinicians to define the QSEN based clinical competencies for mental health nursing. She conducted an 8 hour workshop partnering with these clinical nurses to re-write the competencies for the clinical component of our undergraduate mental health course. The work of these faculty were stimulated by the competitive internal grant monies offered to faculty to implement their creative teaching innovations. In the Doctorate of Nursing Practice (DNP) program, students engage in evidence based practice and learn to use quality improvement methods to implement evidence into their practice. Through the mentoring of QSEN competent faculty, quality and safety are the basis for many DNP practicums. The work of the DNP students can be found on the QSEN website under evaluation. The QSEN Institute is also launching a DNP Corner on the website as a repository for the contributions of DNPs across the country. The QSEN Institute also has stimulated many DNP students to study the science of safety and quality. Examples of DNP projects include the implementation of a quality handoff bundle, identification of factors to predict falls with injury, and the efficacy of a coaching intervention to enhance teamwork and collaboration. Other students who are faculty have tested QSEN teaching strategies to advance our education science.
The work of the QSEN Institute at the FPB School of Nursing served as a catalyst for the Interprofessional Learning Exchange and Development Program (I-LEAD) funded by the Josiah Macy, Jr. Foundation, http://ipec.case.edu/. This grant provided the opportunity to integrate quality and safety competencies into the curriculum at the school of medicine and department of public health. In addition, the QSEN competencies were a catalyst for the integration of a quality committee to oversee the CWRU Student-run Free Clinic. The QSEN Institute also contributed to the establishment of the IHI Open School here on CWRU campus. Nursing students and medical students have been leaders in our IHI Open School Chapter with a mission of students improving the healthcare of the clients they serve. There website can be found at http://www.caseihi.org/. Several of the members of the IHI Open School Chapter have attended the National Telluride Safety camp (medical student in 2012, 2 nursing PhD students in 2013, and 1 nursing PhD student in 2014). There is also an interprofessional quality improvement course now offered as an elective to students for all disciplines. We are launching a Massive Open Online Course that is a replica of this interprofessional quality improvement course in September 2014. This quality improvement course has been taught as an interprofessional course for the last 20 years. The MOOC provides the opportunity for all front line healthcare professionals to learn how to implement quality improvement.
The QSEN Institute transferred to FPB in July 2012 and has been achieving desired outcomes. QSEN faculty and students have published manuscripts with quality and safety as the focus (4 publications and over 20 presentations. Other outcomes include the curriculum changes described above as well as the dissemination activity described below.
In 2012, the QSEN Institute debuted a new website with replication and dissemination as primary objectives. The website includes the QSEN Learning Module series which was designed to help both new and experienced faculty integrate the Quality and Safety competencies into their nursing programs. Each module explores a particular topic or issue, provides resources, and raises questions to engage users in expanding or strengthening the learning experiences they create with students around quality and safety. Module #9 focuses on Managing Curricular Change for QSEN Integration. This is the model that was used at FPB for implementation and dissemination of the QSEN competencies. This module contains all of the tools needed for full implementation of QSEN into a school of nursing. The QSEN Institute plans to continue with dissemination of the QSEN tools through an annual QSEN Forum. This Forum will take place at various regions of the country to encourage participants from all geographic locations. If the prior numbers of participants remains the same, in five years the QSEN Institute will have disseminated the quality and safety message to over 2000 nurses. This year the forum included 100 practicing nurses who are learning how to integrate QSEN into nurse residency programs, staff orientation, and continuing education. We are planning to also have students join us next year to start up a QSEN Student initiative.
The QSEN Institute has involved teams of faculty across programs and disciplines. The current faculty QSEN team are Mary A. Dolansky, PhD, RN, Associate Professor and QSEN Institute Director, CWRU; Shirley Moore, PhD, RN, FAAN, Professor and Associate Dean for Research, CWRU; Deborah Lindell, DNP, PHCNS-BC, CNE, Assistant Professor and Director of the Graduate Entry Program, CWRU; and Rebecca Patton, MSN, RN, FAAN, Instructor, CWRU. There is a national team of faculty involved in the QSEN Institute as well.
The American Association of Medical Colleges (AAMC) invited Dr. Dolansky to participate on their committee for teaching for quality (Te4q). This interprofessional faculty involvement has resulted in the AAMC suggesting to teams across the country to be interprofessional. Dr. Dolansky continues to be a speaker for the Te4Q programs. QSEN also collaborates with the VA Quality Scholars program. Shirley Moore serves as the Nurse Director and Mary Dolansky serves as Senior Faculty in the VA.
The QSEN Institute works to further the mission of AACN by disseminating the AACN QSEN Workshop Modules for both the undergraduate and graduate QSEN competencies; setting standards for quality and safety and providing resources through the website and annual conference. Consistent with the mission of the AACN, the QSEN Institute seeks to develop the next generation of nursing leaders who will impact the quality of our health care system.
The QSEN Institute demonstrates advancement of professional nursing education through nursing education research. As noted above, students in various programs are conducting research projects with a focus on quality and safety with guidance from the QSEN Institute.
Small Schools: St. John's College
The Use of Academic Partnerships to Achieve Interprofessional Education (IPE) Curriculum Innovation
The purpose of this project is to implement a comprehensive curriculum plan for IPE that improves the preparation of baccalaureate nursing students for collaborative practice and patient-centered care. Through the power of academic partnerships, baccalaureate nursing students now participate in a variety of interprofessional simulation and classroom learning activities involving the disciplines of respiratory care, pharmacy and medicine. The goal is that all graduates are prepared for collaborative practice and patient-centered care. The change project began as the nursing program was transitioning to a revised curriculum in the fall of 2013 and was sustained over the past academic year with positive outcomes. To date, the project has resulted in the participation of approximately 200 students across four disciplines, five successful IPE events and several poster presentations to disseminate project outcomes and allow for project replication. Plans are underway to strengthen interprofessional relationships over the next academic year through additional interprofessional opportunities and academic partners.
Project Description: It is often difficult for students in small special purpose colleges to interact with students in other disciplines due to scheduling conflicts and differing learning goals. Until recently, faculty members have held only rare interprofessional education (IPE) experiences within nursing programs at this Midwestern college. Lack of IPE limits student’s opportunities to meet national accrediting expectations that are aligned with Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative, 2011). The use of regional academic partnerships is a creative way to achieve IPE goals. This project serves as a catalyst for educational change within the nursing programs at St. John’s College and has achieved desired outcomes over the past year.
Current enrollment in this special purpose upper division college is 124 students in the general baccalaureate program, including the accelerated baccalaureate cohort and the online RN (Registered Nurse)-to-BSN (Bachelor of Science in Nursing) cohort. Interprofessional academic partner’s geographic location range from 6 blocks away to 90 miles away and include learner group sizes that range from 9 respiratory care students to 80 doctor of pharmacy students.
Teams of faculty in several courses and across academic partners worked with the project coordinator to design and evaluate five varied and innovative IPE experiences for students and interprofessional academic partner students.
The “Civility” event held in the fall of 2013 indicated all Year 1 & 2 Respiratory Care participants and Year 4 Accelerated BSN student participants rated program objectives with a rating of either 3 or 4 on a scale of 1=Not at all to 4=To a great extent. These program objectives included defining covert and overt signs of incivility experienced in practice and educational settings and identifying strategies clinical and educational nursing leaders can use collaboratively to foster civility among nursing staff, faculty and students.
The “Cardio-Respiratory all day event” held also in fall of 2013 with Year 3 PharmD students, Year 2 Respiratory Care students, & Year 4 BSN students consisted of an in-depth high-fidelity simulation, a jeopardy game, and a professional panel discussion, all to highlight IPE, cardio-respiratory care and to evaluate student performance and responses. There was no significant difference on change scores pre and post event on the Readiness for Interprofessional Learning Scale (RIPLS). Pre and post event mean scores on the Team Roles Perception survey indicated that participants levels of agreement were higher post event on both “understanding my role” and “defining the roles of others.” In addition, when comparing cumulative faculty mean scores and cumulative student scores using a two factor analysis of variance, all p values were significant on all items, both on communication and teamwork categories. Furthermore, students scored themselves significantly higher than did the faculty member. Event evaluation scores were positive, for example, the mean score for the item “debriefing allowed me to reflect on the importance of team communication” was 6.25 on a scale of 1=Strongly Disagree to 7= Strongly Agree. This experience concluded with a “Post Experience Blog” revealing rich qualitative information with comments such as: “The IPE day will absolutely have an impact on my future work. I now feel more comfortable communicating with the other professions;” and “The simulation made me realize as the nurse you need to be a patient advocate.”
The “Wit” event held spring of 2014 compared student ratings of the event among Year 2 medical students and Year 4 accelerated BSN students in relation to six interprofessional competencies centered on the topic of death and dying.
The “Newborn simulation” event held in the spring of 2014 indicated consistently higher levels of agreement from Year 1 Respiratory Care students when compared with Year 3 BSN students to evaluation items such as “This IPE allowed me to feel more confident to care for an infant with respiratory compromise”, and “Debriefing allowed me to focus on teamwork”.
Performance measurement is the primary evaluation design. This design serves as both an evaluation tool and a management system to guide decision making and improve program outcomes. Measurements include formative and summative student clinical evaluations, student surveys including the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, 1999), graduate surveys, and employer surveys of graduates. The RIPLS consisting of 19 statements designed to measure student’s attitudes toward shared learning was one tool administered to students for descriptive analysis and comparison. Descriptive correlations are measured among the baccalaureate nursing groups and learners from other professions throughout the various IPE events held over the past academic year. All evaluations align with the Core Competencies for Collaborative Practice (IPEC, 2011) and the Essentials of Baccalaureate Education for Professional Nursing Practice. Every interprofessional experience concludes with participating students evaluating their perceived learning. In addition, the team of college and interprofessional faculty evaluate students’ performance while area employers of graduates evaluate practice performance. Both outcome data and stakeholders feedback are cycled into the feedback loop for evaluation and program improvement at the college.
Discussion: IPE is in its infancy and more research, both qualitative and quantitative, is needed to fully understand best practices in preparing healthcare students for collaborative practice. This successful IPE project innovation served as a catalyst for change within the curriculum and expanded the working relationship of regional academic partners to achieve high quality IPE. These positive experiences led to solid relationships and responsiveness of academic partner interprofessional faculty to join St. John’s College to further their IPE agendas. Clear linkages exist between project inputs, outputs and outcomes. Time spent on the project by the project coordinator, interprofessional faculty, and simulation coordinator have led to planning and development activities resulting in increased faculty involvement, informed stakeholders and innovative IPE development ranging from blogging and classroom learning to panel discussions and team problem solving during simulations. The project has resulted in five successful IPE events, 3 recent regional posters disseminating partial project outcomes and one poster accepted for a national summit. Also of importance, the project has served to enhance interprofessional relationships among institutions and their faculty by meeting a mutually desired level of interprofessional involvement. In addition, several interprofessional faculty scholarship products, as a result of these IPE events, demonstrate scholarship of teaching, which is a particular scholarship focus at St. John’s College. Only examples are provided as full project results are beyond the scope of this letter; however, there are significant findings to date. Outcomes achieved and currently being measured within the change project for the recently graduated students are as follows: (1) Baccalaureate graduates are prepared for collaborative practice and patient-centered care aligned with Core Competencies for Collaborative Practice (IPEC, 2011) beginning in May 2014. (2) Baccalaureate graduates meet national accrediting expectations regarding IPE as perceived by faculty, beginning in May 2014. (3) Interprofessional education partners perceive benefits from interprofessional learning beginning in the academic year 2013-2014. This project results in an integration of IPE throughout the nursing curriculum via didactic interaction, simulation experiences, that assist these graduates to be leaders in the delivery of quality healthcare. In addition, this innovation in professional nursing education increases the involvement and visibility of nursing as a key interprofessional partner while generating new knowledge about the preparation of future nurses.
Interprofessional Education Collaborative Expert panel. (2011). Core Competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
Parsell, G. & Bligh, J. (1999). The development of a questionnaire to asses the readiness of health care students to interprofessional learning (RIPLS). Medical Education 33, 95-100
Private Schools Without an AHC: Fairfield University
In order to respond to the needs of healthcare changes across environments of care, Fairfield University School of Nursing re-examined our Master’s curriculum in order to ensure that we were meeting both the needs of nurses interested in obtaining advanced degrees and the needs of the healthcare system. The MSN in Nursing Leadership (LEAD) was designed. The overall goals were to increase program flexibility to meet student and workplace needs. Faculty approached the redesign of the generic master’s program with the strong desire to integrate the feedback of key stakeholders. The process began with focus groups of leaders from healthcare organizations in the area. A key discussion centered on the question: “What qualities do you want in your future nursing leaders?” Alumni of the existing generic MSN program also participated in structured focus groups to evaluate program content, experiences and opportunities. Other opportunities were to maximize interprofessional education, integrate revised national standards and develop a multi-faceted plan to evaluate the new program outcomes. The new curriculum increases faculty and student collaborations and allows up to 9 credit hours in non-nursing graduate programs. As students in the new program would now have more academic interprofessional learning experiences, the application/clinical portion was also upgraded. In order to develop experiences that would meet IPE competencies, faculty, together with practice partners, designed and developed clinical immersion experiences that will integrate opportunities for interprofessional collaboration for graduate nursing students. Enrollment began in the spring of 2013. The program has met with a very positive response by students, offering a multitude of choices within the curriculum for concentrations in areas of student interest and opportunities for interprofessional education.
Award Criteria: The LEAD program’s goals of richer student experiences and a more collaborative interdisciplinary teaching culture is a model for the campus and very much in keeping with Jesuit Pedagogy. The curriculum allows for creative and scholarly collaborations focused on improving healthcare while allowing nurses to be more self-directed in curricular choices.
The initial outcomes for the first year of the program include exceeding enrollment goals and expanded curriculum options that have met the diverse needs of students through course selections in any of the graduate schools on campus, as well as some off-campus pursuits. An early example of interprofessional experiences in the program is a Spiritually and Wellness course offered through the Graduate School of Education and Allied Professionals. In this course, traditionally offered to graduate students in Counseling and Education, nurses are not only in class with members of other professions but are paired with these non-nursing graduate students for projects and field experiences. In another example, the flexibility of the program allowed a student to pursue an opportunity called The Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Training Program. The LEND Program, offered at another academic institution, is a two-semester leadership training program for those who want to develop skills in advocacy/policy, clinical, research, and teaching that are required for a leadership role in a career focused on children with disabilities and other special health care needs and their families. The student pursuing this opportunity will be able to use the credits earned toward her degree at Fairfield and disseminate the valuable experience in some way through her final practicum on campus.
Although final program outcomes are not yet available, the new program has appeared to be very responsive to student needs, interests and career goals. The students report satisfaction with the flexibility in course selection and enjoyment with course work with faculty and students from the graduate programs across the campus. Enrollment for fall of 2014 included cohorts from two area hospitals looking to strengthen the leadership infrastructure of their nursing workforce in a variety in a variety of roles.
The faculty team designed the new curriculum with replication in mind. As part of the Jesuit academic network, a meeting of Jesuit nursing program leaders is planned for February, 2015, to discuss the innovative curriculum and share project outcomes. The revised curriculum model has been presented at an AACN national conference and a manuscript has been accepted for publication by The Journal of Professional Nursing.
One of the highlights of the program is the development of relationships among graduate faculty of varied disciplines. The nursing faculty team initiated the project as an interprofessional process, partnering with practice leaders and faculty in the other graduate schools on campus. The partnerships will continue to evolve as students move through course work and into practicum experiences working with interprofessional teams to improve patient outcomes. The new curriculum addresses the need to increase interprofessional learning opportunities and develop competencies for students in a university that offers no healthcare profession programs other than nursing. This is a common problem for nursing schools that exist in universities that are not affiliated with academic medical centers. In order to overcome this challenge, School of Nursing faculty met with colleagues from other schools across campus to identify graduate courses that might help students to develop these competencies. In some cases, faculty from across the University joined our nursing faculty to teach or co-teach courses within the nursing curriculum. In addition, elective courses were worked into the new master’s curriculum to offer students the opportunity to pursue areas of professional interest. A list of elective course offerings was developed so that students could consider courses from different disciplines or concentrate in areas such as business, marketing, informatics, biotechnology, communication, education or special populations. This collaborative academic model allows for a richer, more self-directed graduate experience with a great variety of courses offered in the School of Business, Graduate Education and Counseling, Arts and Science and the School of Engineering.
The LEAD initiative fully supports the AACN’s mission of advancing nursing education through an academic program that is responsive to needs of multiple stakeholders, collaborative and respects the diversity of nurses in healthcare. Faculty were dedicated to the standards for master’s education set forth by the AACN, and sought to maximize creative opportunities which would collectively improve population health and the delivery of care.
Conclusion: Academic programs for nursing leadership must be flexible in order to accommodate the changing skill set and competencies needed for the healthcare system of today and the future. Academic and healthcare organizations must maximize resources through collaboration and innovative approaches to delivering a high quality product. Faculty of Fairfield University School of Nursing feel strongly that advancing nursing education means working collaboratively, allowing students more control over curriculum options, breaking down academic silos, and allowing interest and creativity to emerge through scholarship in a rigorous curriculum. The LEAD program demonstrates a curriculum model with countless options for success.
Academic Health Centers: Oregon Health Sciences University
Faculty and administration of the OHSU School of Nursing provided essential leadership in the collaborative efforts that resulted in creation of the new consortium and nursing education curricula. The consortium was created in 2002 and has served as a catalyst for change in nursing education throughout Oregon and the nation since that time. The Oregon Consortium for Nursing Education1 is a partnership of Oregon nursing programs (9 community college ADN programs and the OHSU BSN program) dedicated to educating future nurses. Faculty members from these partners have created a shared curriculum taught on all consortium campuses. The curriculum was created and continues to be maintained and revised by faculty representing all the partner programs. Through OCNE, students can complete coursework for the Bachelor of Science Degree in Nursing from OHSU without leaving their home community. Students on OCNE community college campuses complete the Associate of Applied Science degree in nursing and are eligible to take the RN licensure exam, then have the option to continue directly to OHSU senior level coursework required for the Bachelor’s degree through various OHSU campuses or through distance delivery of the didactic portion of the courses and local completion of the clinical experiences.
The OCNE curriculum is an innovative design based on a set of core competencies educating a nurse who can provide care to individuals, families and communities in health promotion, acute or chronic illness and at the end of life. The graduate from an OCNE program is skilled in clinical judgment, culturally appropriate & relationship-centered care, systems thinking & leadership, and evidence-based practice.
OCNE is often cited as an initiative primarily focused on increasing access to baccalaureate education, and this has been one of its goals. This goal would be consistent with AACN’s mission and vision as well as the IOM recommendations. However, OCNE actually encompasses multiple initiatives necessary to meet the overarching goal of aligning nursing education with the emerging health care needs of Oregonians - Partnerships and Collaboration, Curriculum Transformation, Pedagogy Reform, and Clinical Education Redesign.
This comprehensive and collaborative effort is unprecedented in the United States and is increasingly viewed by health care and nursing education leaders as a model that could be adapted to achieve similar goals across the country.
Nationally, OCNE has inspired nursing faculty around the country to engage in education redesign in order to align nursing education more closely with emerging health care needs and health care system changes, and to increase educational capacity for baccalaureate education. Through conferences, publications, and webinars, faculty in 12 states have actively deliberated whether to develop programs like OCNE. So far, at least 10 states have seen the greatest effects: components of the OCNE program have been adopted in Massachusetts, Texas, New York, and rural North Carolina, while statewide or regional consortia have been developed in California and Hawaii and continued active planning is occurring in New Mexico, Wyoming, Minnesota, and Maine. My colleague from OHSU and fellow Co-director of OCNE, Paula Gubrud-Howe, recently returned from consulting with nursing educators in Maine at the same time I was consulting with MANE—the Minnesota Alliance for Nursing Education which is developing a new curriculum and relationships along the lines of OCNE.
More information can be found at http:/ocne.org.
Illinois Wesleyan University
Our curricular advancement entitled “An Innovative Study Abroad Program for Nursing Majors at a Traditional Liberal Arts University” meets the award criteria and is described below. To our knowledge, no other small private liberal arts undergraduate institution offers a semester long study abroad experience for nursing majors embedded within the curriculum; we believe our Spain program, which is entering its third year being open to nursing majors, is truly an innovative approach to establishing cultural competence for undergraduate nursing majors and could serve as a model for other small schools and private universities.
In response to an increased need for Spanish speaking and culturally competent nurses, Illinois Wesleyan University implemented a semester-long study abroad program for nursing majors in Barcelona, Spain, as an innovative strategy to assure the newly revised curriculum meets the changing needs of society. Curricular revision incorporated The Essentials for Baccalaureate Education for Professional Nursing Practice and met the Institute of Medicine’s recommendations for core knowledge needed for all healthcare professionals. Previously, student travel abroad was limited to May Term or summer for nursing majors due to the limitations of delivering a traditional pre-licensure program at a liberal arts university. Nursing majors can now participate in the University’s study abroad program, allowing both the study abroad students and the students who remain on campus to enhance their appreciation for cultural and ethnic diversity. The School of Nursing’s mission, philosophy, and goals are consistent with that of the University’s emphasis on preparing students for democratic citizenship and life in a global society and “extends the University’s liberal arts tradition to prepare exceptional thinkers, compassionate professionals, and leaders for nursing and global healthcare.”
In Spring 2012, five sophomore nursing majors experienced immersion in Spanish language and culture while living with families in Barcelona. The program grew to seven sophomore nursing majors participating in 2013. These pioneers enrolled in two non-nursing classes, at Barcelona International College, including a Spanish language course and a course that met general education credit. Through the use Polycom technology, the study abroad students and the students on campus synchronously completed Pathophysiology and Pharmacology II and the didactic portion of Nursing Foundations II: Health Promotion and Risk Reduction with IWU School of Nursing faculty. Clinical observation experiences in Barcelona assured students could collaborate with other healthcare professionals and patients to provide culturally appropriate health promotion and disease and injury prevention interventions. Demonstration of competency in fundamental nursing skills and completion of 40 hours of direct patient care occurs when the students return to campus in May. Michele Bromberg, Nursing Coordinator, The Illinois Department of Financial and Professional Regulation (IDFPR), described the IWU Spain program as “on the cutting edge of facilitating bilingual healthcare workers in the state of Illinois.”
Qualitative and quantitative data obtained from student participants demonstrate the success of the study abroad program. Feedback from 2012 was used to improve the 2013 program and plans are underway to assure the success of the twelve sophomore nursing majors studying in Barcelona in 2014. Teaching strategies employed for a successful study abroad experience include 1) techniques to create a dynamic classroom learning environment for both students on campus and those abroad (e.g., increasing bandwidth speed; installing more monitors/speakers); 2) ways to assure ongoing communication and academic success (e.g., Skype study session with tutors and faculty); 3) techniques to accommodate different test taking needs (e.g., providing both paper and electronic testing options). Administrative strategies included 1) grant writing to secure and update telepresence technology; 2) an agreement and establishment of a relationship with an international institute of higher learning; 3) multiple site visits beginning 2 years in advance to secure several clinical observation sites to accommodate cultural variations in agency agreements and ongoing visits to assure learning needs are met. Additional lessons learned from the inaugural year that were applied to the seven nursing majors who traveled in 2013 included the need to 1) assure a dedicated study space for students outside of home stays and beyond limited hours of libraries and universities; 2) inform students of the demands of skill-based modules and clinical experiences upon return to campus; 3) delay clinical observation experiences in Barcelona until acclimation to the culture and language skills are more developed; 4) enhance technology support services including the development of more than one contingency plan for technology challenges; 5) pre-departure meetings with returning students, faculty, and staff to prepare departing students for the rigorous demands of the study abroad program for nursing majors; 6) pre-departure planning sessions with the Study Abroad Director (a faculty colleague in Hispanic Studies or other non-nursing discipline) and Internship Coordinator (an international colleague on site in Barcelona) to assure the unique needs of nursing majors are addressed.
In summary, the Illinois Wesleyan University study abroad program for nursing majors in Barcelona, Spain, is an innovative approach to allow cultural immersion and advance cultural competency at a traditional liberal arts university. Sophomore nursing majors can spend the Spring semester immersed in Spanish language and culture while living with host families in Barcelona. As part of the Spain Program, students take language and general education courses offered through Barcelona International College while using PolyCom for synchronous learning of IWU core nursing course content. This approach honors the face-to-face learning environment that defines Illinois Wesleyan’s small private liberal arts residential campus. Students participate in Spanish clinical observation experiences in public and private health care centers and complete direct patient care requirements upon return to campus in May. Participation in the semester long study abroad allows nursing majors to experience the global opportunities available to all University students while allowing the nursing majors, who report having a “life transforming experience” to graduate on schedule with their classmates who remained on campus.
Private Schools Without an AHC: D’Youville College
During the current 2012-2013 academic year, D'Youville College School ofNursing began an innovative approach to interprofessional education (IPE) in collaboration with the other six health care professions at the college. The objective ofthe D'Youville College (DYC) interprofessional education committee (IPEC) is to develop a working model that meets the core competencies of IPE and fosters patient-centered collaboration across professions. DYC has responded by creating a curriculum containing a four hour simulated patient scenario experience, centered on the IPE core competencies of: values and ethics for interprofessional practice, roles and responsibilities, interprofessional communication, and teams and teamwork. The objective was successfully met with 254 students and 25 faculty members from the seven health care professions participating in the experience.
Faculty created a "Year in the Life of Chris Dulles", 4 authentic fictional patient scenarios that occur throughout a continuum of care settings (Outpatient clinic, CCU and medical/surgical hospital floor). Actors from the on-campus theater were trained as simulated patients/family members. The curriculum strives to ensure practicing health care professionals function as a holistic integrated team delivering high quality patient-centered care. Within the scenarios, undergraduate nursing seniors and graduate family nurse practitioner students and students from multiple health professions are required to work together while recognizing the unique and complementary contributions of members of the health care team. Debriefing sessions provide an opportunity for students to increase their understanding of the IPEC competencies and talk about the experience of working together on a team. The simulated patient experience includes faculty and students from Nursing in collaboration with faculty and students of the other healthcare programs at the college: Chiropractic, Dietetics, Occupational Therapy, Pharmacy, Physical Therapy, and Physician Assistant. Student learning was assessed via pre and post measures for achievement of interprofessional competencies as proposed by the Interprofessional Education Collaborative.
To promote the practice of teamwork and collaboration and the understanding of each other's roles on the health care team, experiences integrated into the curriculum can begin to change the culture of isolated practice. On the college campus the culture change has begun between the faculty and students across the health professions as they work together in the simulated encounters. The experience also supports the D'Youville College mission that emphasizes leadership development of students.
The innovation began in February 2012 and is continuing. The outcome of educating the 7 health professions through the IPE experience was successfully met by refurbishing an off campus location with video, live feed, and simulated patient spaces; creating patient scenarios; training actors as simulated patients; educating faculty facilitators; collecting student assessment data; and successfully bringing 254 students through the experience. The IPEC simulations will be continued in all the health professions curricula in the next school year.
This IPE experience can be replicated. The experience is being disseminated by several members of the IPE faculty who have presented at their respective professional conferences. Moving forward, groups of faculty have begun to work on papers for publication to be submitted in the next year. The scenarios have been placed in a consistent format to be shared. The group has submitted further grant applications to expand space and equipment with intent to expand the experience to additional student cohorts and expand the IPE objectives. The model developed can be replicated by other schools with multiple health professions with which to partner.
All seven ofD'Youville College's health care professional programs are included in each simulation experience. Initially, the organizing faculty committee was comprised of one member of each profession; five faculty members attended the 2012 IPE Institute. The group has expanded to 14 with two faculty members from each professional school plus the 25 trained faculty facilitators from the college some of whom are non-healthcare faculty members. The inclusion ofnon-healthcare professionals in the experience enhances the resources ofthe group and has opened discussion about roles of the college business and liberal arts departments, and the library for future projects.
This initiative supports the AACN's position in the IPEC organization to heighten collaboration among all providers to advance high quality, integrated healthcare delivery. The educational experience supports the Baccalaureate Essential of interprofessional communication and collaboration for improving patient health outcomes by creating an experience where collaboration among health care professionals is learned and not left to happenstance in the clinical setting.
Teamwork and collaboration have been shown to affect safety and quality outcomes for patients. Interprofessional education of our future health care professionals can take this culture change and teamwork example directly into practice to affect patient care outcomes. The faculty committee chose interprofessional simulation encounters with simulated patients as its first initiative to provide deliberate experiential learning about team communication skills and respect for each other's roles. In addition, learners experience shared accountability in striving to improve the quality and safety of patient care.
Public School Without an AHC: Texas A&M University-Corpus Christi
Academic Health Centers: The University of Texas Medical Branch at Galveston
Three outcome objectives were accomplished through this project. The first objective was the development of an Electronic Statewide Distance Training Program (Court Visitor Program or CVP). This program was designed to provide training for undergraduate nursing students as Court Visitors, for the purpose of making annual visits to Wards (legally) incapacitated on behalf of the Texas Probate Courts and to monitor quality of care provided by their guardian. The online program consisted of 12 modules containing nursing and legal theory relevant to Court Visitor functions with pre and posttest and a final exam over all content.
The second objective was the implementation of an Electronic Statewide Court Visitor Program within the clinical portions of undergraduate nursing courses, such as psychiatric and/or community health nursing. Ten (10) probate court jurisdictions were targeted for inclusion in the Project. The CVP has been implemented in four (4) counties encompassing five (5) schools of nursing, two (2) schools of medicine, and one (1) school of physical therapy. It is projected that in 2012-2013 the CVP will be expanded and implemented in five (5) additional counties encompassing four (4) schools of nursing and one (1) Texas administrative agency (Department of Aging and Disability located in Cameron County).
The third objective of the project was the evaluation of the Electronic Statewide Court Visitor Program. The evaluation was conducted to ensure the infrastructure to support the availability and sustainability of a full range of healthcare skills and services to Wards, eliminate health disparities and assure quality of care. One thousand and eighty (1080) Wards & one hundred and eighty (180) nursing students were targeted for inclusion in the project. To date, approximately 300 nursing, medical and physical therapy students have made annual visits to over 800 Wards of the Court, filing Guardianship Court Visitor Reports describing quality of and access to care. Further, CVP training has been provided to dozens of nursing faculty and court personnel.
The Court Visitor Program (CVP) was funded by the Health Resources and Services Administration (HRSA) for the period of 2009-2012, for the purpose of implementing the CVP statewide. This program would facilitate the Wards’ access to quality care across the State of Texas. There are approximately 20,000 Wards of the Court and 20 Court investigators, who must monitor annually the quality of care provided to the Wards by the guardians. In response to this imbalance of 1000:1 and Texas Statutory Law, the Court Visitor Program was established in Galveston County in 2001, in collaboration with UTMB School of Nursing, via the clinical of an undergraduate psychiatric course, to assist the Court with these annual visits. In summary, within the CVP, the Probate Courts are utilized as clinical sites, and pairs of students make visits to the incapacitated at their place of residence.
Meeting the Award Criteria
The CVP Model has served as a catalyst for change within the curriculum and/or educational mission of each of the institutions in which it has been implemented. One of the most significant changes was in the area of forensic involvement and expansion. Included within this change was the expansion to an interdisciplinary team that included nursing, medical and physical therapy students and, the addition of a pilot program using the CVP model in the undergraduate pediatric nursing clinical experience which will serve as the basis for the development of a HRSA grant focusing on a statewide pediatric assessment project and its use of the established CVP sites.
The CVP model has broad implications and serves as a basis for the development and addition of a pain management project, the expansion of the community health experience to work with criminal courts that are providing rehabilitation services of individuals with driving under the influence (DUI) offenses. Each of the sites is currently involved in collaborating with Dr. O’Keefe in the development of a publication. The site faculty provides the scholarly focus and Dr. O’Keefe provides the data analysis and interpretation. Finally, Dr. O’Keefe has actively involved nursing PhD students in data analysis for publications.
The CVP has been very successful mainly because of the ease of replication and online dissemination. The CVP is flexible so that all aspects of the training program and Report to the Court may be easily adapted to meet the academic needs of the School of Nursing and the evidentiary needs of the probate Courts. Over the 2 ½ year period of the project, each clinical site has become self-sustaining, as once a trainer is provided, the collaboration is established with the Court, and students enroll in the online training program, the involvement with Dr. O’Keefe becomes minimal and typically includes only sharing of data analysis.
The development and implementation of the CVP has involved teams of experts across the nursing, medical, allied health & legal professions. Not only are the disciplines of law, nursing and medicine involved in the delivery of care, but also teams of social and community health workers, court investigators and American Association of Retired Persons volunteers participate in this interdisciplinary team.
The CVP is consistent with the mission of the American Association of Colleges of Nursing (AACN), as this service learning project addresses the public interest of providing quality care to a vulnerable population by monitoring the standard of care provided by the guardians, providing nursing students as resources to monitor that care, and developing the leadership capacity of The University of Texas Medical Branch School of Nursing to advance nursing education at School’s of Nursing around the state of Texas, provide research experience for Advanced practice nursing students, and provide a clinical practice site for undergraduate students.
Additionally, The CVP provides training for highly educated trainers and diverse undergraduate nursing students to lead the delivery of quality health care to a vulnerable population and the generation of new knowledge to improve health and the delivery of care services to the incapacitated.
This project has demonstrated advancement of professional nursing education through achievement of AACN Goal 1 which addresses providing strategic leadership that advances professional nursing education, research and practice. The project has led to innovations in baccalaureate and graduate nursing education (noted previously) that have promoted high quality health care for the incapacitated and is providing new knowledge generation for ongoing program revisions. In addition the implementation of the project has enabled the establishment of collaborative relationships and formed strategic alliances between Schools of Nursing across the State of Texas, to advance baccalaureate nursing education. And finally the project’s visibility and success has increased the visibility and participation of nursing's academic leaders in each site and promoted the vision and mission of advocating for innovation in nursing education.
This innovative project has been very successful and has provided a variety of learning experiences for students. It is because of the creativity of this project and its successful implementation that I sincerely hope that the committee will review this innovation favorably.
Small Schools: Misericordia University
During the academic year of 2009 an IPE coalition (NEPA-IPEC) was formed which consisted of 12 multidisciplinary programs par¬ticipating in interprofessional activities in Northeast¬ern Pennsylvania. The goal of NEPA-IPEC was to hold collaborative activities to serve as forums to share and exchange interprofessional experiences. The first two IPE activities had more than 100 multidisci¬plinary students participating at three designated sites throughout the Commonwealth.
This is an example of the first IPE activity that was presented. At the beginning of the program, students were gath¬ered in the auditorium. A speaker presented informa¬tion related to the goals for this experience and gave information related to IPE. The group viewed a video which showed a disheveled man who was confused and unable to communicate to staff when presenting at the emergency room carrying a bag of medication. Stu¬dents then broke into groups of 10, having two facilita¬tors from different disciples to lead the discussion. Ice breakers and introductions were used to identify the disciples in each group. Students were asked to dis¬cuss considerations for the care of this gentleman from various perspectives (i.e., physical therapy, speech medical student, physician assistant, nursing, social work, anesthesia and advance practice nursing). One Misericordia University was a key player and provided the venue for the first IPE summit. These types of summits can be used as a mechanism to have students from multiple disciplines explore ethical is¬sues, define professional roles and responsibilities, promote interdisciplinary communication through teamwork and collaboration which are consistent with the core competencies for Inter-professional collaborative practice. Students are facilitated in this process through questions related to each member’s role and scope of practice. The goals for students participating in these types of activities are to expand the students’ knowledge of oth-er health professions and to promote inter-professional understanding of other health professionals’ roles and responsibilities to patient care. It is hopeful that stu¬dents will reflect upon the identification of healthcare professional roles and responsibilities and use such opportunities to collaborate in ways to improve patient. Scenarios change yearly however the outcomes remain the same.
This type of student engagement served as a catalyst for change by integrating learning for our students across disciplines. This is consistent with the mission of our university in that the university is committed to provide quality education to our students and to shape its education programs and policies to express the founding Sister’ values, and attitudes of mercy, service, justice, and hospitality. It is consistent with the AACN mission in that it serves the public interest by setting standards, provides resources, and develops leadership capacity of member schools to advance nursing education, research, and practice.
This program is in place since 2009 and has been successful and all of the participants are enthusiastic about the continuation of it. Response rates on surveys for 2010 and 2011 find that 86.6% - 92.6% respectively found the summit an effective way to understand the role of other health care professionals in the care of patients. The following desired outcomes of this program continue to be met each year:
1) Expand students’ knowledge of other professions and promote interprofessional understanding of other health professionals’ roles and responsibilities in patient care.
2) Identify and discuss gaps and mismatches in understanding of one’s health discipline and other disciplines in the context of patient care.
3) Promote personal reflection about the identification of healthcare professional roles and responsibilities.
This model can be easily replicated in small colleges who do not have a lot of interdisciplinary programs. The greatest amount of energy is the coordination piece which is handled by one key person from each program taking the lead and representing the program at organizational meetings. Other AACN programs who participate in this summit are Wilkes University, Marywood University, and the University of Scranton.
The following are the ways that the IPE summit meets the award criteria:
The IPE Summit served as a catalyst allowing a small school to be able to participate in an interdisciplinary experience without having all of the resources on the campus. It provided a mechanism for a yearly IPE experience.
The first Summit was in the spring of 2009 and continues to attract students to three campuses yearly.
A manuscript was published in Pennsylvania Nurse to disseminate this information in an effort to stimulate replication of similar programs. (Mailloux, C. (2011). Interprofessional education: Positive effects on patient outcomes. Pennsylvania Nurse 66 (2), 12-13).
A future endeavor to look at another collaborative experience in Viet Nam is being investigated with the Commonwealth Medical College and Misericordia University.
This IPE experience reinforces Misericordia University’s dedication to the mission and vision of AACN to continuous improvements in quality, efficiency, and accountability through an evidence-based curriculum which prepares undergraduate nursing students for entry into professional nursing practice and fosters a commitment to life-long learning. This program is consistent with the core competencies identified by the expert panel for Interprofessional Collaborative Practice (2011).
The nursing program continues to engage in Interprofessional collaboration within the university also. At the present time we have an Interprofessional pilot project within the College of Health Sciences, involving collaboration between nursing faculty and faculty from the Speech and Language Department. The project entails baccalaureate junior nursing students and baccalaureate junior speech and language students working together on pharmacology patient case studies. The goal of our project is to help our students work collaboratively, problem solve, and to enhance a sense of professional role while finding the optimal outcome for the patient.
Private Schools Without an AHC: Lourdes University College of Nursing
Lourdes University is a Private School without an AHC. It could also be considered a small school with a University student enrollment of 2386. The College of Nursing BSN program enrolls 272 students in the nursing Major. The faculty in the College of Nursing ambitiously took on the task of revising the entire BSN curriculum between 2009 -2011 to meet the changing demands of the healthcare arena for quality and safety, complexity of care in the acute care as well as the community setting and outcome based and population focused care. This initiative took place at the time that the Carnegie Foundation released the landmark study of nursing education in the United States by Benner, P., Sutphen, M., Leanard, V., and Day, L. (2009) “Educating Nurses: A Call for Radical Transformation”.
After 18 months of weekly meetings, the faculty designed a curriculum which was framed by the Quality and Safety Education for Nursing Education (QSEN) curriculum funded by Robert Wood Johnson and endorsed by AACN, incorporated the values of population focused care and evidence based practice as fundamental concepts, was driven by concept verses content and built around integrated clinical experiences. This cutting edge curriculum was initiated in August 2011 and will complete the first year of implementation May 9, 2012.
The nursing faculty decided to create this new curriculum based on concerns that the patchwork changes of the curriculum over the years were fragmenting the conceptual framework, the American Association of Colleges of Nursing new set of Essentials for Baccalaureate Education in 2008 necessitating modifications to our current curriculum and the Institute of Medicine’s “To Err is Human” report about safety concerns in health care delivery. All of these factors called for a transformation in nursing education that builds on essential concepts of quality and safety; that stresses development of clinical judgment, and fosters a professional identity that emphasizes accountability and responsibility. As a result, the BSN curriculum was transformed.
The goal of the Lourdes University College of Nursing curriculum is to graduate students who possess the knowledge skills and attitudes (KSAs) to impact both individual and system approaches to patient safety and thus transition readily into complex health care systems (QSEN competencies). The additional conceptual themes of culture, value centered care; community and leadership provide students with the context needed to effectively work with diverse populations. The first semester of the nursing major emphasizes, along with core physiological and psychosocial nursing concepts essential for safety, the KSAs related to patient centered care, communication and evidenced based practice. The students will apply these concepts in a community based clinical setting emphasizing skills of professional communication, especially active listening and understanding patient care needs within the context of environment and culture. Psychomotor skills are introduced but not emphasized.
Subsequent semesters expose students to increasingly complex patient care needs and take the students into more complex health care settings. With a strong foundation in the KSAs of safety, communication and evidence based practice; students move on to develop competencies in interdisciplinary collaboration, informatics, and quality improvement within comprehensive health care systems. Clinical placements integrate concepts across courses and move from the community into tertiary care centers. All clinical placements are designed to increase the students’ time in one setting and system in order to observe and evaluate outcomes of care. In the final semester students are placed with nurses employed in the practice setting to complete a professional practicum. The students also engage in a capstone course in which the six QSEN based concepts are fully integrated with the remaining conceptual themes.
The plan of study includes a total of 125 credit hours within a 15 week semester model. Students complete general education courses, prerequisite courses and 60 hours of coursework within the nursing major. A student is able to finish the coursework in 4 years.
This new BSN curriculum has provided our students and the College of Nursing extraordinary opportunities. We presented the new curriculum to ProMedica Health Systems, a locally owned nonprofit healthcare organization serving northwest Ohio and southeast Michigan, and we were able to collaborate for a grant to support quality and safety education for student nurses as well as practicing nurses in our region. As a result of this collaboration, the College of Nursing was awarded a $984,000 over three years from the U.S. Health resource and Services Administration (HRSA), Division of Nursing, Nursing Education, Practice, Quality, and Retention Grant (NEPQR) grant program.
To disseminate the vision and reality of this innovative curriculum change, the College of Nursing is sponsoring a spring conference on May 14 and 15, 2012 to the nursing education and practice community in Northwest Ohio called “Transforming Academic/Clinical Partnerships: A Focus on Quality and Safety Education for Nurses (QSEN). Keynote speakers, Jane Barnsteiner PhD, RN, FAAN and Mary Dolansky PhD, RN will provide the presentations on safety, teamwork and collaboration as well as patient centered care, evidence based practice, informatics and empowering students in quality improvement. The Lourdes College of Nursing faculty will provide presentations on the implementation of this type of curriculum, lessons learned and content oversaturation in nursing education.
Curriculum implementation is new and data collection for outcomes has just begun. However, a series of focus groups with current students demonstrate a general sense of satisfaction and excitement. Ongoing process evaluation with faculty reveal role development as they learn to work in collaborative semester based teams. Response to student learning has been positive, noting improved ability by students to understand patient needs in context and improved critical thinking earlier in the curriculum.
This has been an exciting endeavor for the nursing faculty and the BSN students. They have moved forward understanding the risks and the determination required to make this type of curriculum change successful and sustaining. This innovative integrated, concept driven, quality and safety based BSN curriculum is a paradigm shift from traditional nursing education curricula. This initiative had required perseverance, dedication, creativity and stamina. It is my pleasure to nominate the Lourdes University College of Nursing faculty for the AACN “Innovations in Professional Nursing Education Award”.
Public School Without an AHC: Kent State University
Kent State University College of Nursing (KSU CON) was nominated for the Innovations in Professional Nursing Education Award for their re-envisioning of traditional nursing education content through implementation of the Care for the Caregiver Consortium. Beginning with a single faculty member (Tracey Motter), nine faculty members within the College of Nursing, as well as faculty from social work and psychology from nine universities across six states, have collaborated to advance the Care for the Caregiver Consortium. Inspired through an innovative partnership with Donna Karan's Urban Zen Integrative Therapy Foundation, we are building programmatic change that will support student self-care. Not on ly will this change enhance graduates' professional presence at the bedside, but it provides the foundation for a multidisciplinary program of research aimed toward sustained change in the quality of nursing education and practice.
The goal of the KSU CON Care for the Caregiver Consortium is to integrate self-care practices into undergraduate nursing curricula and to demonstrate, through a related, interdisciplinary and multi-institutional program of research, how effectively self-care practices contribute to the socialization of new nurse graduates to strengthen their value for and practice of self-care strategies. To date, Care for the Caregiver content has resulted in revision of our introductory nursing courses, and as a catalyst for change beyond our own curriculum, has opened partnerships that already are demonstrating potential to enhance the quality of nursing education, research, and evidence-based practice nationally. We have already begun to see the effects of strengthened resiliency among students and faculty, as both groups engage in Care for the Caregiver activities on the Kent State campus.
At the College of Nursing, the Care for the Caregiver Consortium emerged initially as an effort to address high levels of stress expressed by accelerated, second-degree, baccalaureate nursing students, whose chaotic lifestyles appeared to challenge their abilities to focus on and deal with the demands of the accelerated, undergraduate nursing curriculum. The lead faculty member for the introductory accelerated course (Tracey Motter) was concerned that without attending to their own needs, students and graduates would be limited in their ability to demonstrate compassion at the bedside.
Serendipitously, in early 2010, a Kent State University alumnus connected Kent State University's Vice President for Advancement with Donna Karan, fashion designer and philanthropist. What was not clear, initially, was that in addition to her passion for fashion design, Ms. Karan shared a passion with nursing faculty for nurses' self-care. As her husband, Stephan Weiss, was dying of lung cancer in June, 2010, he had admonished Donna to "take care of the nurses." Ms. Karan viewed the interests of KSU CON faculty as supportive of her own commitment to implementing self-care for nurses nationally.
Following a series of meetings, a partnership emerged between Karan's Urban Zen Integrative Therapy Foundation and the Kent State University College of Nursing. In August 2010, faculty introduced a group of 30, newly-admitted, accelerated BSN students to Care for the Caregiver Consortium philosophies of patient- and self-care, integrating both specific Urban Zen modalities (yoga, Reiki, aroma therapy, breath awareness, and meditation) and nursing content into the introductory nursing course. As they completed the course, participating students shared feedback with faculty indicating that they valued the content and that it enhanced their personal senses of well-being.
Based on student feedback from the Fall 2010 cohort, Care for the Caregiver content was offered to the incoming group of newly-entering second degree students in Spring, 2011. As this offering was initiated, involved faculty who were early adopters conducted a quasi-experimental pilot study to assess the influence of the content on: 1) students' perceived stress levels, using the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983); and 2) students' abilities to be mindful, present in the moment, and focused, using the Mindful Attention Awareness Scale (Brown & Ryan, 2003). Analyses of data from both instruments showed that compared to a comparison group, students in the Care for the Caregiver (treatment) group (n=18) maintained their stress at constant levels from beginning to end of the introductory nursing course, while the stress levels of the comparison group of traditional students in their introductory nursing course (n=20) increased over the course of the semester. In regard to mindfulness, students involved in Care for the Caregiver programming demonstrated increasing skill, relative to comparison group students whose mindfulness skills did not increase over the semester. Although, probably because of sample size, group differences in average mindfulness scores was not statistically significant, findings trended in the expected direction, and the study was expanded.
During Spring 2012, the sample in this quasi-experimental, students from nursing programs at Cleveland State University and Ursuline College were enrolled in the study, which increased participant numbers to 60 Care for the Caregiver students and 80 comparison students. Preliminary analyses of narrative data indicate that students highly value the content included in the Care for the Caregiver curriculum. Data collection was expanded to include three time points, and we will have completed analyses by early Fall 2012.
Adoption of self-care innovations to enhance the quality of professional nursing education continues. First, nine Kent State University faculty members have committed to including Care for the Caregiver Consortium content in their nursing courses, across all programs. In preparation for the re-envisioning of curricula for those courses, all relevant faculty will be trained in self-care modalities. Second, in March, 2012, Kent State College of Nursing planners dedicated the annual "Driving the Future Conference" to self-care and its modalities. The ail-day continuing education-credit bearing program entitled 'Self-Care and Wellness' included an keynote presentation by Dr. Cynda Ruston (Transforming Moral Distress into Healing) intended to contribute directly to bridging the gap between education and practice; self-care sessions led by yoga experts Rodney Yee and Colleen Saidman Yee from the Urban Zen Institute; a presentation by Donna Karan to initiate newcomers to the significance of nurses' self-care; and afternoon breakout sessions focused on research, educational re-envisioning, and self-care. Approximately 200 educators and students, from across disciplines, attended. Third, university administrators worked with the College of Nursing to offer an evening gala that included donors from insurance, healthcare, business, and publishing to celebrate the successes of Driving the Future and to introduce them to the Care for the Caregiver Consortium (and to the Kent State University School of Fashion Design and Merchandising). Fourth, the following day, March 6, 2012, faculty from nine universities and practice sites across three disciplines (nursing, psychology, and social work) spanning six states met together, with representatives from the Urban Zen Institute, in an all-day summit called Changing the Future to examine strategic directions for integrating self-care into nursing education and nursing research. Led by faculty and administrators from the College of Nursing, the summit resulted in development of a white paper and in delineation of next steps for re-envisioning nursing education to incorporate self care and to foster programmatic change nationally.
This exciting initiative has achieved more than desired outcomes; demonstrates excellent potential for replication and dissemination nationally; has involved teams of faculty across nursing programs and across disciplines. As importantly, it serves to advance not only professional nursing education but also the quality of patient care, as it provides self-sustaining skills to nursing students, to help them understand the importance of self-care to the quality of the work they will do. The work is groundbreaking in linking educational strategies to patient outcomes and is especially trailblazing in its interdisciplinary focus.
Advancing Professional Nursing Education
The Care for the Caregiver consortium is consistent with the mission and vision of AACN, as it serves the public interest by setting standards to promote quality nursing education; secures resources to advance awareness and study of those standards; and strengthens leadership capacity of participating units to advance education, research, and practice-not only for nursing but interprofessionally. The Care for the Caregiver Consortium provides support for AACN's vision in that it contributes to the goal of meeting the demand for innovation and leadership in nursing education, research, and practice. We believe that the Care for the Caregiver Consortium will continue to serve as a catalyst for change in nursing education and research as it is replicated nationally and involves increasingly broad teams of faculty. Outcomes of the Care for the Caregiver Consortium will contribute significantly to the advancement of professional nursing education; that contribution will be evidenced through a program of related research that demonstrates the merits of the Consortium for facilitating student success, enhancing quality of nursing education, and strengthening patient care.
Academic Health Centers:
University of Wisconsin-Madison
The AACN Innovation in Professional Nursing Education Award on behalf of the University of Wisconsin-Madison School of Nursing under the Academic Health Center (AHC) category.
The Early Entry Option-PhD Program: In an effort to address the need to attract younger, more diverse students into careers in nursing research, UW Madison nursing faculty have developed a pre-baccalaureate entrance into the existing PhD program, known as the “early entry option” (EEO). This option allows academically qualified students who have been admitted to the BS major to be screened and admitted to the nursing graduate program in order to provide seamless progression and preparation for a career in research.
By way of context, the University of Wisconsin-Madison is one of top research universities in the world, with more than $1B in research expenditures in 2009. It enrolls approximately 5000 freshmen each year. The middle 50% of the entering freshman class each year is characterized by GPAs of 3.5 - 3.9, ACT scores of 27-29, SAT scores of 1860-2090, and class ranks in the top 10-15%. The School of Nursing benefits from the academic rigor at Wisconsin, as students apply to the BS nursing major at the end of their second year (or four semesters) of undergraduate study. Admission to the nursing major is likewise highly competitive. In Fall 2010, the School of Nursing screened 371 qualified applications for 154 available slots in the BS Nursing program. The resulting admit class included 58 students with an earned baccalaureate degrees and 10 students with advanced degrees, and the average GPA for the class was 3.5.
Nursing faculty sought to develop a pathway whereby talented students who were already admitted to the BS nursing major and who signaled an interest in nursing science could simultaneously be evaluated for admission into the PhD program. The goals were: 1) to accelerate progression of selected nursing students from the BS through to the PhD, 2) to capitalize on the School of Nursing’s exceptionally strong undergraduate applicant pool and on the rigorous research training model already in place in the PhD program.
The EEO option was launched in 2003. After admission to the BS nursing major, students may then apply to the EEO. Requirements are similar to the graduate school application process on campus (i.e., written application including a statement of career goals and potential research interest, review of test scores and transcripts, references, and interviews with program faculty). Once admitted, EEO students are assigned a three-member advisory committee (undergraduate advisor, faculty advisor, and an assistant dean) who help the student plan their program. EEO students earn a BS (a minimum of 124 credits), an MS or MS/MPH (a minimum of 16 credits) and a PhD (a minimum of 54 credits). Theoretical and clinical course work is consistent with the AACN Essentials for baccalaureate and masters education. The school commits substantial scholarship funding to EEO students during the undergraduate portion of the program, and EEO students receive top priority for available graduate student funding.
The program consists of three integrated components: theoretical courses, early and intensive research training, and clinical practice. Theoretical and clinical course work is consistent with the AACN Essentials for baccalaureate and masters education. Some graduate courses may be substituted for undergraduate courses, if the student is progressing well. Research training is begun early and is integrated through the program. As undergraduates, EEO students participate in the undergraduate honors program and complete an honors thesis. This provides the framework for identifying a faculty mentor and a research focus. During this experience, EEO students are matched with a faculty advisor (major professor). The “goodness of fit” between student and faculty mentor is deemed critical for success. If this match is successful, the faculty mentor typically assumes responsibility for research training throughout the remainder of the program. The EEO student joins the faculty’s research group in weekly meetings, can interact with more advanced doctoral students and witnesses first-hand the challenges of planning and implementing a program of research. As students progress into graduate course work, they begin to refine possible research questions and approaches. They also participate in a weekly research colloquia series that exposes them to the breadth and depth of research in the school. Clinical practice is likewise integrated throughout the first three years, as students complete 12 credits of undergraduate clinical nursing courses and 3 credits of advanced practice clinical coursework. Clinical experiences are individualized wherever possible to support the student’s developing research focus.
Progression guidelines have been developed for each year of the EEO-PhD program; benchmarks and evaluative criteria include performance in required courses, selection of faculty mentor, progress in research (i.e., poster presentations, submission of manuscripts), progress in securing funding (i.e., applications for research funding or fellowship applications). Evaluation of student progress is the responsibility of the advisory committee. Since the program was launched in 2003, 21 students have enrolled, and attrition to date is 48%. We learned some important lessons about student selection in the first four years (2003-2006), as 7 of the first 10 students completed the baccalaureate, but did not continue into the PhD portion. In the subsequent four admit classes (2007-2010), only 3 of 11 have left after completing the baccalaureate degree.
At present, 11 students are in the EEO: five undergraduates (3 first year, 2 second year), and 6 doctoral (1 first year, 2 second year, 1 third year, 1 fourth year, 1 fifth year). Of these 11 students, 8 were ages 19-22 at admission, and 3 were ages 24-27. While this student group is predominantly female (10 female, 1 male), 4 are from underrepresented populations (i.e., Hispanic/Latina, African American, Hmong). Their average admission GPA was 3.6 (range 3.49-3.96) and average composite ACT was 26 (range 20-32).
The first graduate of the EEO defended her dissertation in December 2010, having earned her BS in 2004 and her MS in 2007. She had received an NIH Individual Predoctoral Traineeship, and was a Hartford Building Academic Geriatric Nursing Capacity Scholar. She had 6 publications and 8 research presentations to her credit, and was 28 years old at time of graduation. The next two graduates are progressing beautifully; they are expected to complete in 2014, and both will be under the age of 30.
This model clearly attracts much younger and more diverse students into our PhD program, and it is clear that they can be successfully transitioned from admission to the nursing major through to the PhD. We know from talking with our undergraduate students that the presence of EEO students in their midst has elevated the profile of nursing research and careers in education. The development and implementation of the EEO-PhD has stimulated important faculty discussions about the core of the nursing discipline, how that core is reflected in our BS, DNP and PhD programs and how those programs must connect. It has required faculty in our baccalaureate and PhD programs to collaborate in new ways, and has required our experienced investigators to reach out to a wider array of faculty colleagues across campus in order to support, and literally to keep up with the research interests of this “new breed” of nursing doctoral student.
I believe our innovative EEO-PhD model can be borrowed, replicated and improved upon in any university nursing environment where there are academically strong undergraduates, where faculty can ensure early and continuous engagement of students in research training, and where faculty are prepared to engage the „future of nursing? at very close range by working with doctoral students who are very different from those in our past, but who have enormous potential. My faculty colleagues believe so much in the promise of this model to build the nursing professoriate of the future that we are actively shifting our PhD recruitment to focus to a much greater extent on entering BS students, and to include entering freshmen (major as yet undeclared) at Wisconsin.
I myself have been engaged in doctoral education in nursing for more than 30 years, and am convinced that programs like this one will literally chart new directions for our discipline for decades to come. I hope that your committee shares our excitement, as I know that my faculty colleagues would be most honored to receive this important award. I will look forward to hearing the results of your deliberations, and thank you for your service to AACN.
Small Schools: Wilkes University
The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at Wilkes University under the Small School category.
In 2009, the Lasater Clinical Judgment Rubric (LCJR) was adopted by the Clinical Nursing Simulation Center (CNSC) at Wilkes University School of Nursing (WU-SON) as the evaluation tool which would be used to measure the development of clinical nursing judgment in undergraduate baccalaureate nursing students. In an effort to assure quality, efficiency, and accountability in the implementation and evaluation of this tool in the simulation program, a statistical database was created.
The database is structured to include cases for all students enrolled in the baccalaureate nursing curriculum at Wilkes University beginning with the Fall 2009 semester. The purpose of the database was to provide a means for the CNSC to:
analyze quantitative statistical data on students and student cohorts;
access and analyze data in order to objectively evaluate simulation program outcomes;
monitor, analyze, and evaluate the development of clinical nursing judgment in the individual throughout program progression; and
have access to historical data for longitudinal studies;
This database was initiated in the 2009-2010 academic year to store student data collected during simulation activities and to enable the CNSC to use this data to perform statistical analysis of clinical judgment (LCJR) scores for specific student cohorts. The results of the statistical analysis provided quantitative data which supported the objectives and goals of the simulation program, which was initially integrated into the nursing curriculum at the beginning of the 2008 academic year. The database is currently being expanded so that further statistical analyses can be done to determine relationships and correlations on multiple variables as a means of assuring quality, efficiency, and accountability in the implementation and evaluation in other aspects of the undergraduate nursing curriculum. Data obtained through this database also have been useful in advancing faculty interactions with the CNSC, and vice versa, which have in turn, led to changes in the curriculum and instruction in courses, the clinical setting, and the CNSC.
The mission of the Wilkes University School of Nursing is to prepare professional practitioners of nursing who have mastered the core concepts and principles of the discipline, to address ethical issues in practice, to promote lifelong learning and to serve others with intelligence, compassion, and integrity in a constantly evolving, multicultural environment. Consistent with this mission and the vision of the WU-SON, simulation integrated into the undergraduate nursing curriculum is designed to prepare professional nurses for an evidenced-based practice in an increasingly complex healthcare environment.
The role of the simulation program in this curriculum is to create a learning environment in which undergraduate nursing students are exposed to complex clinical situations in a standardized and controlled simulation setting. The goals of the simulation program are to provide a system by which students can develop clinical nursing judgment and to employ a standardized and centralized mechanism by which the development of clinical judgment is objectively evaluated in order to provide feedback to enable curricular changes for continuous quality improvement.
Program and Program Outcomes
In 2006, Wilkes University began to explore the use of simulation in undergraduate nursing education and, in 2007, the CNSC was established with the intent of integrating simulation into the undergraduate nursing curriculum using the philosophical underpinnings of Benner’s Theory From Novice to Expert. The goal of the simulation agenda is to provide a mechanism by which students are exposed to complex clinical situations followed by a formative debriefing session as a means to assist in the development of clinical nursing judgment. In 2008, an educational session was held on simulation and faculty began integrating clinical simulations into each clinical nursing course. At the end of the 2008 academic year, systematic review of the curriculum and evaluation of the simulation agenda revealed a need for an objective method by which this clinical nursing judgment can be evaluated.
In response to this identified need, the Lasater Clinical Judgment Rubric (LCJR) was adopted as the evaluation tool. The LCJR was chosen because it is consistent with the philosophy of Benner and it was specifically designed to measure a student’s clinical judgment during performance in clinical simulations in cognitive, psychomotor, and affective domains of learning. The LCJR scoring gives a quantitative measure of a student’s clinical judgment and establishes a level of development for each student as either beginning, developing, accomplished, or exemplary. The LCJR and scoring parameters were distributed to all faculty during an educational session held at the beginning of the 2009 academic year.
In an effort to assure quality, efficiency, and accountability in the implementation and evaluation of the simulation agenda integrated into the nursing curriculum, a SPSS database was also created in 2009 so that data on student clinical judgment can be centralized and used for analysis of both student and program outcomes. Also, because the LCJR was new, the SPSS database included variables to monitor inter-rater reliability.
While the simulation program and database were designed specifically for pre-licensure students, the importance of such a program in the evaluation of students was recognized. The graduate curriculum for Nursing 542: Evaluation in Nursing Education was updated to include the LCJR, its scoring parameters, and the importance of inter-rater reliability. The graduate students enrolled in that course participated in student evaluations using the LCJR in clinical simulations in the CNSC beginning in 2009.
Data collected using the LCJR to evaluate students’ clinical nursing judgment in simulations were entered into the database and analyzed based on student cohorts of sophomore, junior, and senior. Data analysis showed that both mean and median LCJR scores were higher for the junior level cohort as compared to the sophomore level cohort and LCJR scores were higher for the senior level cohort as compared to the junior level cohort. It was also noted that the range of scores for the sophomore level cohort was larger than the range of scores for both the junior level cohort and the senior level cohort. And the range of scores for the junior level cohort was larger than the range for the senior level cohort. An independent-sample t- test comparing the mean scores of the sophomore students (NSG210) and the mean scores of senior students (NSG310) found a significant difference between the means of the two groups (t(88) = -2.684, p <.05). The mean of the sophomores is significantly less (m = 25.98, sd = 6.86) than the mean of the seniors (m = 29.48, sd = 5.27).The results suggest that overall clinical judgment skills improve as students transition through the baccalaureate nursing program and clinical judgment skills become more consistent among students as they approach program completion.
As the simulation program is dedicated to the mission of the WU-SON, the use of the database to demonstrate the development of clinical nursing judgment in the enrolled students supports the School’s mission to prepare professional practitioners of nursing who have mastered the core concepts and principles of the discipline. Curricular changes that resulted from the new simulation program are:
The School of Nursing’s philosophy for the undergraduate curriculum was rewritten based on the philosophical underpinnings of Benner,
All clinical nursing courses in the baccalaureate curriculum now have an integrated clinical simulation to evaluate the students’ clinical judgment,
Nursing 542 in the master of nursing program now includes content and assignments on the evaluation of clinical judgment in pre-licensure students using the LCJR,
School of nursing undergraduate curriculum reports and systematic evaluations now include statistical data on student cohorts’ clinical judgment development which support the curricular changes.
The curricular changes that came about from the introduction of the new simulation agenda were well-received by faculty and administration. The program development and results were presented by the CNSC Director at the International Nursing Association for Clinical Simulation and Learning (INACSL) Conference in Las Vegas in June 2010 in an effort to stimulate curricular changes in nursing education that will foster large-scale changes for the integration and evaluation of development of clinical nursing judgment in pre-licensure nursing students.
Data continue to be entered into the database and descriptive statistical data is reported as part of the CNSC’s monthly report. In 2010, WU-SON faculty requested use of the database as a central and standardized method for storing not only information on simulation but also other variables that can help in evaluating the undergraduate nursing curriculum. During the 2010-2011 academic year, the CNSC Director met with the Assistant Dean of Academic Affairs and Assessment and the WU-SON Associate Dean to begin expanding the statistical database to allow for routine analysis of quantitative statistical data on students and student cohorts in cognitive, psychomotor, and affective domains and provide access to this historical data for longitudinal studies. In the Fall of 2011, educational sessions will be held for all WU-SON faculty so that use of the statistical database becomes an integral part of systematic evaluation.
Meeting the award criteria
This program served as a catalyst for change by integrating a simulation agenda into the undergraduate nursing curriculum using the philosophical underpinnings of Benner’s Novice to Expert Theorem
This program was implemented in 2009-2010 academic year, was sustained in the 2010-2011 academic year, and is now a part of the ongoing systematic evaluation of the School of Nursing.
Information on this program was disseminated via conference podium presentation in an effort to stimulate replication of similar curricular changes in other nursing programs.
This program was a collaborative effort by the administration, faculty, and staff of the Nesbitt College of Pharmacy and Nursing.
This database reinforces Wilkes University’s dedication to the mission and vision of AACN to continuous improvements in quality, efficiency, and accountability through an evidence-based curriculum which prepares undergraduate nursing students for entry into professional nursing practice and fosters a commitment to life-long learning.
Private Schools Without an AHC: (TIE)
Texas Christian University
The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at Texas Christian University (TCU) – Harris College of Nursing and Health Sciences (HCNHS) under the Private School without an Academic Health Center category.
The purpose of the Baccalaureate Nursing Emphasis in Oncology (BNEO) at Texas Christian University (TCU) - Harris College of Nursing & Health Sciences (HCNHS) is to increase nursing students’ desire and decision to practice in an oncology setting upon graduation. Established in Spring 2008, the programmatic innovation offers baccalaureate nursing (BSN) students the opportunity to complete an emphasis in oncology within their generalist nursing preparation. The program has demonstrated success in recruiting students to oncology nursing after graduation as well as serving as a curricular model for other areas of nursing for BSN students. TCU’s academic partnership with the University of Texas Southwestern Medical Center (UTSW) provides the opportunity for our students to experience oncology clinical opportunities in a National Cancer Institute designated center.
Description of the Programmatic Innovation
There is a dramatic need for oncology-specialized nurses to care for the growing population of people diagnosed and living with cancer, as well as for caregivers of cancer survivors. The Baccalaureate Nursing Emphasis in Oncology (BNEO) is an innovative strategy to promote interest and skill development in oncology nursing among BSN students. The BNEO program used the Oncology Nursing Society (ONS) Standards of Oncology Nursing Education: Generalist Level Education as the framework for the development of the oncology curriculum and collaborative clinical experiences (Jacobs, 2003). Graduates of the program have been well-prepared and motivated to enter oncology nursing practice.
Courses developed or supplemented for the oncology emphasis program are guided by the criteria statement from ONS: “To ensure that the science of and technical skills associated with the physical, psychosocial, spiritual, and cultural care of the patient with cancer necessary when examining prevention, early detection, risk reduction, treatment, rehabilitation, palliation, and/or end-of-life principles are included (Jones, 2003).” Although oncology nursing is an established specialty, many nursing programs lack focused oncology clinical and didactic experiences for students resulting in a failure of students to explore careers in oncology after graduation. The foundation for the BNEO is two upper-division undergraduate courses.
Aspects of Oncology Care is a three-credit course that requires didactic and outpatient rotations coordinated with the Simmons Comprehensive Cancer Center at the University of Texas-Southwestern Medical Center (UTSW). Didactic content is provided in an intradisciplinary approach by oncology clinical experts at HCNHS, UTSW and other oncological resources in the community. Clinical experiences for each student are required and coordinated through the outpatient clinics at UTSW. These include four 8-hour days in these clinics: Bone Marrow, Infusion, Gynecology-Oncology, Surgery, Radiation, & Hematology/Oncology, as well as the Interdisciplinary Care Clinic. Students also join the Oncology Nursing Society and attend local chapter meetings; becoming engaged in the professional aspects of oncology nursing.
The second course, Oncology Residency, is a three-credit hour, precepted internship with an oncology certified registered nurse. Students are placed on the adult general oncology unit, bone-marrow unit or pediatric oncology unit at one of three hospitals associated with UTSW medical system. Students complete nine 12-hour shifts and must demonstrate that they can competently and independently care for up to four oncology patients.
An additional aspect of the program is an Oncology Internship Program coordinated collaboratively with a large local oncology physician group with opportunities for urban and rural settings. BSN students must apply for the Oncology Internship and have successfully completed Aspects of Oncology Care. Interested students submit an essay speaking to their interest in oncology and career goals. A committee of oncology nursing faculty and nurses from the oncology group select participants for the internship. Students selected have experiences in medication administration, intravenous starts and accessing venous access devices, dressing changes, patient monitoring, opportunities to gain an understanding of case management and financial aspects of oncology patient care, and caring for the caregiver and family.
Since inception of the BNEO, 75 students have completed Aspects of Oncology Care (38 have graduated) and 23 students have completed the Oncology Residency (16 have graduated). Twenty-four students have entered oncology nursing upon graduation. Twelve students have participated in the Oncology Internship Program. The practice site for the Oncology Internship has employed one of the participants full-time upon graduation and continues to use three of the program graduates part-time.
As part of the BNEO, professional development opportunities have been offered to all TCU students, members of the entire TCU community (faculty/staff), the community of Fort Worth, and Dallas–Fort Worth professional cancer care providers. These have included continuing education (CE) workshops on radiation oncology; prostate cancer, cervical cancer, breast cancer, cancer prevention for women, and most notably, an annual full-day CE symposium for oncology nurses. These offerings have enhanced the relationships of the TCU–HCNHS reputation for being on the forefront of oncology practice for nursing and served to establish HCNHS as a baccalaureate program for students interested in oncology as a nursing specialty area.
In addition to the standard undergraduate nursing curriculum, assignments and activities in several other standard nursing curriculum required courses have an oncology-emphasis requirement for students participating in the program. With assistance from Community Partners, students participate in expanded didactic and clinical content on long-term effects, caregiver concerns, palliative care, primary, secondary and tertiary prevention, as well as end-of -life care and decision-making. Partners allow students to participate in and experience the valuable role of an interdisciplinary approach to cancer care from diagnosis, survivorship and end-of-life. Graduates of the program have been able to immediately contribute to institutions and communities as knowledgeable health care providers regarding services and needs of cancer survivors along the survivorship continuum.
The BNEO meets award criteria in the following ways:
Catalyst for change within the curriculum and/or educational mission of the institution. The Oncology Emphasis has served as a model for two subsequent initiatives: gerontological nursing course with interprofessional practicum experience and perioperative nursing course. Since initiation of the BNEO there has been a documented increased interest, not only dialogue, among faculty about oncology, but also research and community programming in oncology.
Sustained for at least one year and met outcomes. The program has been sustained since January 2008 and has met outcomes for student participation, faculty collaboration and awareness, and fostering community partnerships. The program has increased enrollment from 10 in year one to 30 this past year; and the number of graduates being employed in an oncology setting has consistently increased with each cohort.
Involved faculty teams. In addition to the standard undergraduate nursing curriculum, assignments and activities within several other required courses within the standard nursing curriculum have an oncology-emphasis requirement for students participating in the program.
Consistent with AACN mission and vision. The innovation is an exemplar of a strategy to meet human and societal needs through nursing. It is a proactive strategy to prepare baccalaureate nurses who are ready to respond to emerging knowledge about cancer and the increasing need to effectively care for survivors and their caregivers in a variety of different settings.
Demonstrates advancement of professional nursing education. The program highlights the role of the baccalaureate nurse in oncology care and demonstrates nursing’s commitment to prepare individuals ready to collaborate with other disciplines and community agencies to meet the needs of persons with cancer, survivors, and their families.
Recent literature documents that a shortage of registered nurses in oncology is a reality that the profession must address, given an aging population, concurrent aging of the oncology workforce, the nature of cancer, and increased number of cancer survivors. Specific to the National Action Plan for Cancer Survivorship, the program supports the prioritized need for the development of specific oncology curriculum, clinical experiences and an externship that students do not currently participate in. However, students have the opportunity to participate in the oncology internship. Curriculum content is aligned with care across the lifespan focusing on the issues of survivorship for cancer patients.
Nursing students frequently see cancer as a fatal condition and believe that oncology nursing lacks the complexity or excitement found in other clinical settings. By providing focused clinical experiences in different oncology settings and oncology-specific curricula, the BNEO has achieved its major aim to increase the number of baccalaureate nursing graduates that select a career in oncology nursing. In addition, the innovative program can be implemented and sustained in other programs of nursing.
Centers for Disease Control and Prevention and Lance Armstrong Foundation. 2004. A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. Atlanta: Centers for Disease Control.
Jacobs, L., ed. 2003. Standards of Oncology Nursing Education: Generalist and Advanced Practice Levels. 3rd ed. Pittsburgh: Oncology Nursing Society.
University of Detroit Mercy
The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at University of Detroit Mercy under the Private School without an Academic Health Center category.
Dramatic changes in health care, movement towards a global society, continued budgetary restrictions, learning needs of new millennium students and increasing multidisciplinary efforts to accomplish a variety of goals were a few of the reasons the University of Detroit Mercy (UDM), McAuley School of Nursing (MSON) recently initiated an innovative multidisciplinary nursing course into the curriculum. The overarching goal of the multidisciplinary effort is to train students how to effectively collaborate with members of other disciplines, advance nursing education and improve practice in order to ameliorate care. The school of nursing has established collaborative relationships and formed strategic alliances with the school of engineering, local health care providers, and the surrounding community and by doing so has advanced baccalaureate nursing education. Multidisciplinary collaboration in baccalaureate nursing education has the potential to create fertile grounds for learning beyond that of a single discipline approach. Specifically nursing and engineering faculty have developed a way to inspire and stimulate their students to learn and use the knowledge they’ve gained to provide care to their clients. This innovative multidisciplinary educational approach effectively meets the learning needs of our current students while helping members of our community.
In 1988, the US Federal Government passed the Technology-Related Assistance for Individuals with Disabilities Act (“Tech Act” 2000). Increasing the availability of assistive technology as well as the capacity to provide technology-related assistive devices were two objectives of the federal act. Accordingly, in 2008, the departments of Nursing and Mechanical Engineering at UDM collaborated to provide unique assistive devices to physically challenged individuals living in the Detroit Metro Area while teaching multidisciplinary collaboration. Following classroom instruction the student teams, under the supervision of the nursing and engineering faculty, meet people from the local community with a physical disability. Individuals requiring assistance are identified through a variety of developed partnerships such as Michigan Rehabilitation Services, Veterans Administration (VA) Hospitals, Michigan Spinal Cord Association and personal contacts. The students interact with the client to assess his or her needs. Collaboratively, the students and the client determine a device that could be built in order to improve the life of the disabled person. Nursing students inform the team about the specific physical disability and its implications, help with design ideas and evaluate the device and the client for any potential health related issues. Engineering students design and build the assistive devices identified by the client and make necessary iterations until a satisfactory device is completed. The multidisciplinary student team works together to provide a safe, useful and health conscious device with the goal of improving quality of life. Nursing faculty and engineering faculty collaboratively teach bi-weekly in the classroom and also facilitate the multidisciplinary student interactions as they build the devices for the clients.
Description, Outcomes & Title
The title of the program is “Enhancing Education Using a Multidisciplinary Program Building Assistive Devices for Physically Disabled People”. The goal of this interdisciplinary educational effort is to teach collaboration and team work between disciplines in order to prepare graduates with skills necessary to work in a global society while positively impacting the lives of others. The collaboration between mechanical engineering and nursing in this manner lends support to Kijima’s (2007) encouragement to advance multidisciplinary work in the systems sciences where one system is mechanical and the other human. The outcomes for the course are as follows: 1.) Students will have an improved understanding of the roles engineers [nurses] have in the development of assistive technological devices. 2.) Students will demonstrate improved collaborative and communication skills with members of other disciplines. 3.) Students will state enhanced understanding of how to apply learned skills to a variety of problems. 4.) Students will be exposed to needs of people in the community and design strategies to improve those needs. 5.) Students will state an anticipated enhanced ability to communicate across disciplines in the workplace post-graduation compared to their colleagues without multidisciplinary training. Pre and post course surveys of students demonstrated that all outcomes have been effectively met.
Since the initiation of the multidisciplinary course both nursing students and engineering students have had the unique opportunity to learn collaborative skills which serves as a catalyst for change to nursing curriculum, with the goal of additional multidisciplinary opportunities incorporated into other nursing and university courses. MSON is advancing professional nursing education by offering this unique type of multidisciplinary education. In addition, the faculty teaching the multidisciplinary course have disseminated information on how other universities can replicate this program. The goals, purposes and techniques of this unique learning experience has been presented at the American Association of Colleges of Nursing Baccalaureate Education Conference (November, 2010), the Michigan Academy of Science Arts and Letters Annual Conference (March 2010), the Nurses Trusted to Care Conference (May 2011 – poster), featured on Pubic Network Television (August 2009, http://www.youtube.com/watch?v=DNmE3TxQ828) and published in a pending issue of Michigan Academician (in press). It is our hope that other colleges and nursing programs will begin to incorporate similar programs into their curriculum with the goal of graduating nurses proficient in applying their nursing skills in expanded ways. Nurses need to have input when devices, technology and electronics are being designed for patients. Currently, far too few products being used in clinical settings have been influenced by the expertise of the nurses who will be using them. It is our goal that nurses lead the delivery of quality health care and help generate new knowledge to improve health and the delivery of care services. In order to accomplish this objective, consistent with the AACN vision, nurses need to be educated to communicate and collaborate with other disciplines in order to enhance technology used in clinical settings and patient lives.
We have just completed our third year of the multidisciplinary nursing/engineering course. The program is consistent with and fully supports the mission of UDM which states, “The University of Detroit Mercy, a Catholic university in the Jesuit and Mercy traditions, exists to provide excellent student-centered undergraduate and graduate education in an urban context. A UDM education seeks to integrate the intellectual, spiritual, ethical and social development of our students.” Our program develops students by educating them to use their intellectual skills learned throughout their courses at UDM in order to improve the lives of people living in our urban community with physical disabilities. The students also include the spiritual, ethical and social aspects involved in providing for the needs of the physically disabled living in an underserved area. In addition, our multidisciplinary course provides resources which serve the public, is creatively, uniquely and innovatively advancing nursing education and practice to meet the demands of the 21st century health care, objectives consistent with the mission of AACN.
Our program was recently awarded a NCIIA grant (#8286-10, “Student designed technologies for the disabled”) which will financially contribute to additional and improved devices that our students can build for the physically disabled persons in our urban community. The multidisciplinary student efforts have produced innovative devices such as: a hand grasper for a former police officer with right sided hemiparesis from a gunshot wound to the head, an ankle strengthener / exerciser for a man with multiple sclerosis, a torso & triceps strengthener for a paraplegic man, a side sliding crib for a wheelchair bound mother, a motorized wheelchair mover for non-electric wheelchair users, a liquid food feeding tool for burned patient unable to feed himself liquids due to contractures and loss of fingers, a camera stabilizer for a photographer with Huntington’s Chorea, and laundry tub extractor for a woman with Spina Bifida.
We have encountered some limitations in our collaborative course. For example, scheduling conflicts and time constraints between nursing and engineering students have made team meetings occasionally difficult to schedule. Also, initial differences in professional language and jargons make communication between disciplines somewhat problematic. However, the initial language barriers become an outcome met towards the end of the term as each discipline begins to learn and understand how to collaboratively communicate with the other discipline. The faculty view this phenomenon as meeting course objectives 1, 2 & 5. An example of this is noted during the stage when a perceived design is presented to the client but revisions are needed. The engineering students refer to revisions as “iterations”; the nursing students refer to revisions as “alterations to interventions”. Interestingly, by the end of the term both groups of students understand the others language without explanation. Another example is the ease that nursing students understand and can explain words like spina bifida, contractures, and hemiparesis to the engineering students but also leave the course understanding words like gantt chart, prototyping, and sequential dependency.
Despite some challenges to multidisciplinary education, the nursing and engineering students have stated that the course had a positive impact on their realization of the needs of people in the community and how their unique skill sets can be used collectively to ameliorate those needs. The students have also verbalized an improved understanding of the need for multidisciplinary efforts in the workplace to design equipment built by engineers, used by nurses to improve health care. Both the engineering students and the nursing students have stated an enhanced understanding of the others’ discipline and have expressed a desire to work with other disciplines as a means to improving care. In addition, lives of physically disabled people in our local community have been positively impacted because two very different disciplines have learned to work together.
Please do not hesitate to contact us if you have any additional questions regarding our awesome multidisciplinary program. We are very proud of this work and the impact it will have on the future of baccalaureate nursing education.
Public School Without an AHC: University of Texas at Austin
Academic Health Center: University of Maryland
Innovations in Professional Nursing Education Award for the University of Maryland School of Nursing under the category of Academic Health Center (AHC). A description of the programmatic innovation, outcomes, and a detailed explanation of how the award criteria were met are included.
Evidence-based practice (EBP) student learning outcomes were enhanced in the undergraduate and graduate curriculum through an innovative approach involving faculty and community stakeholders. The process included a comprehensive assessment of all program curricula by faculty experts, linking student learning outcomes with employer stakeholder expectations for practice after graduation, working with faculty groups to revise curricula, and implementing and evaluating the changes. Not only were student learning outcomes improved, but a need was identified for a new 12-credit EBP certificate that focuses on the EBP process, translation strategies, and measuring outcomes.
In 2008, two University of Maryland School of Nursing (UMSON) faculty experts were charged with conducting a review of the research and EBP content in the baccalaureate (BSN), master’s (MS, including clinical nurse leader), doctor of nursing practice (DNP), and doctor of philosophy (PhD) programs and making recommendations to integrate appropriate research and EBP concepts across academic programs. The faculty experts 1) abstracted appropriate items from the relevant AACN essentials (Essentials of Baccalaureate Education for Professional Nursing Practice, Essentials of Master's Education for Advanced Practice Nursing, and Essentials of Doctoral Education for Advanced Nursing Practice); 2) created a grid of each program’s goals, expected outcomes, and courses to drive discussion; 3) reviewed syllabi for BSN, MS, DNP, and PhD research courses; 4) met with course coordinators and faculty members who teach BSN, MS, DNP, and PhD research classes to review the appropriate AACN essentials for the program and research course objectives, requirements, and evaluation approaches; 5) met with and obtained input from the specialty directors for the nine master’s specialties; and 6) met with and obtained input from the Research Council at University of Maryland Medical Center.
Implementation of changes
A team of faculty members reviewed the assessment and implemented revisions. The grid of program goals, expected outcomes, and courses was revised to include planned revisions. At the BSN level, most clinical sites expect new graduates to be able to rate and grade evidence, search for evidence, critique evidence, incorporate evidence into practice, and identify areas where no evidence exists. The importance and interplay between quality improvement (QI) and safety with EBP for newly prepared RNs was identified. Changes to the curriculum included refining EBP content to include standardizing critique, data collection tools, and rating scales and incorporating discussion of the clinical utility of research and how patient preferences and professional decision making affect recommendations. Safety and QI content was incorporated into EBP.
At the MS level, clinical sites expect graduates to possess baccalaureate competencies and be able to plan organizational changes and QI initiatives based on evidence; participate in and lead evidence-based processes; and develop or update clinical guidelines, protocols, and policies based on evidence. Enhancements of the EBP content included standardization of the EBP process, comparison of research process and EBP process to reinforce the importance of understanding how both processes complement one another, and methods for conducting a higher level of critique, data analysis, synthesis, and translation of research evidence than at the BSN level. In addition, utilization of advanced methods such as systematic reviews and meta-analysis were incorporated into the courses to promote more complete state-of-the-science summaries of evidence.
Formative and summative student course evaluations were conducted. Results indicate that that curriculum changes were effective in achieving learning outcomes. Students completed the standard UMSON five-point scale course evaluation at baseline (spring and summer 2008) and after the curriculum changes were made (summer 2009 and fall 2009). Means are reported for spring/summer 2008 and summer/fall 2009, respectively. From baseline to the post curriculum revision, mean evaluation for the BSN research course improved from [M=4.1, 4.0(N=182)] to [M=4.3, 4.1(N=128)]. The MS research course means did not change post curriculum revision [M=3.9, 4.4(N=174)] to [M=4.1, 4.2 (N=173). To better assess if the changes in the MS curriculum were important to students, formative evaluation was also conducted. In fall 2009, 165 students from five classes completed a 10-item survey using a five-point scale (1-unimportant to 5-very important) to evaluate the usefulness of various course components. Over 80% of the students evaluated the following curriculum changes to be important or very important: application exercise, developing PICO (Problem Intervention Comparison group Outcome) questions, EBP paper, and evidence critique.
Development of a new EBP certificate to meet health care needs. Throughout this process, faculty members and community stakeholders recognized that curriculum revisions were important, but not sufficient to meet the needs for advanced EBP leadership within health care institutions. Organizations such as the American Nurses Association, the American Nurses Credentialing Center Magnet program, and The Joint Commission require evidence of nurses incorporating research findings and other forms of information as a guide for practice. Because of this expectation, there is an escalating demand for resources to help nurses learn EBP skills and to secure the infrastructure necessary to implement EBP. Four local acute care hospitals were queried to determine if a need existed for a 12-credit graduate-level EBP certificate. We received immediate responses from 35 nurses who notified us of their interest and an immediate need for this program.
A team of faculty members and PhD-prepared nurses from the clinical setting developed the UMSON Evidence-based Practice Certificate. The certificate is aimed at enhancing the knowledge, skills, and attitudes of master’s-prepared nurses to promote EBP in health care organizations.
The certificate program consists of 12 credits: two 3-credit didactic courses (EBP Process and Evidence Translation), one 2-credit didactic course with a 1-credit practicum component (Clinical and Administrative Outcomes), and one 3-credit practicum (EBP Practicum). The curriculum is designed to be taken one class at a time over the course of four semesters. The didactic coursework ensures the theoretical knowledge necessary for EBP, including models of EBP, searching for and appraising the research and non-research evidence, translation strategies, and evaluation techniques. The practicum is designed to provide experiential learning by requiring the student to conduct and complete an EBP project. The first group of students will be admitted in fall 2010 and graduate in May 2012. All courses have been approved by the University of Maryland, Baltimore Graduate School, and the certificate is pending approval by the Maryland Higher Education Commission.
How Award Criteria Were Met
This innovation served as a catalyst for change within the curriculum of the institution. The EBP changes for the BSN and MS curricula not only served as a catalyst for change within each program, but resulted in a new program aligned with educational mission of the UMSON. The EBP Certificate is responsive to the needs of health care institutions that hire our graduates, and will provide a new population of students with the necessary skills, knowledge, and attitudes. These students are nurses who have leadership responsibilities, but have not had EBP content in their academic preparation. Coursework and mentorship will provide these nurse leaders with the education and experience needed to support the development of infrastructure that fosters EBP in health care settings.
The changes associated with this innovation were sustained for at least one year and has achieved desired outcomes. This project began with a curriculum assessment in 2008. Changes were implemented in spring 2009. The change has been sustained over one year from spring 2009 through spring 2010. We have achieved and exceeded expected student learning outcomes as evidenced by formative evaluation of MS students and summative evaluation of changes from baseline to post curriculum changes for both BSN and MS students.
The innovation has the potential for replication and dissemination. The process used to assess, recommend, implement, and evaluate EBP curriculum changes can be replicated using the same tools if faculty is engaged and linkages between academic and clinical partners are established.
The innovation has involved teams of faculty across programs and community stakeholders. The curriculum revision involved teams across programs and engaged clinical partners to establish competencies needed in the clinical setting for graduates at the BSN and MS levels. In addition, each MS specialty has an advisory board that includes employers. Employers provide us with input on how well our graduates are prepared to enter the work force. One of their identified needs was for the students to conduct and lead EBP projects in their facilities.
The innovation is consistent with AACN’s mission and vision. This curriculum innovation is clearly aligned with AACN’s mission and vision. The AACN Essentials of Baccalaureate Education for Professional Nursing Practice, Essentials of Master's Education for Advanced Practice Nursing, and Essentials of Doctoral Education for Advanced Nursing Practice were used to guide the curriculum review (setting standards and providing resources), and the curriculum revision was responsive to developing leadership capacity in a member school to advance nursing education and practice. Building EBP knowledge, skills, and attitudes in nursing leadership will help to achieve the AACN vision for the profession that “By 2020, highly educated and diverse nursing professionals will lead the delivery of quality health care and the generation of new knowledge to improve health and the delivery of care services.” This initiative further aligns with AACN’s organizational vision “as a driving force for quality health care” that prepares schools to meet “the demand for innovation and leadership in nursing, education, research, and practice.”
The innovation demonstrates advancement of professional nursing education. This project demonstrates advancement of professional education because not only did it result in curriculum revision to improve the EBP skills of our graduates, but has led to the development of a new education product: the EBP Certificate program. The EBP certificate meets an immediate and pressing clinical need by forging a partnership between academia and the clinical setting. Each class will be co-taught by a faculty member and a doctoral-prepared clinical partner.
Small School: Nazareth College
The United States Department of Education and the European Commission on Higher Education jointly funded this program in 2008. The overarching goal of the project is to improve higher education in health. The partners in an existing collaborative initiative between Laurea University of Applied Sciences in Finland, Nazareth College in the United States and Semmelweis University in Hungary shared a common concern for preparing and retaining a well-educated nursing workforce. The funding provided by external agencies ($1.2 million dollars) enabled expansion to improve higher education and health by preparing nurses with a global perspective to provide culturally competent care through the development of a transatlantic dual-degree program. Specifically, the major goals of the program were: 1. Prepare a culturally competent international nursing workforce and globalize the nursing workforce through educational experiences. 2. Create mechanisms for the exchange of undergraduate students majoring in nursing. 3. Develop a dual-degree model to facilitate the growth of the nursing workforce by developing international nursing leadership with a global, trans-cultural perspective. 4. Share evidence-based practice standards for education that cross international boundaries.
The worldwide nursing shortage has created the need for an innovative program that harnesses the enthusiasm of students wishing to pursue a global education. At the present time, there are numerous programs in nursing that offer an international focus in nursing. A limited number of semester study abroad programs exist in nursing. However, no dual transatlantic degree programs in nursing could be identified when the project was started. The partners have established an excellent cooperative base on which to build a model transatlantic dual-degree program in nursing. The curriculum utilized by the partners in this consortium has the potential to be an international model for cooperation and transparency in professional nursing education. The Essentials of Baccalaureate Nursing document developed by the American Association of Colleges of Nursing (AACN) was utilized to guide the partners in delivering a program with recognized core competencies and outcomes. The document provided specific standards for educational components that were consistent with nursing documents developed through the Bologna Process in the European Union.
Outcomes: The first dual degrees were awarded in Spring 2010. The degrees awarded are recognized in the United States and Europe (Hungary/Finland). Another outcome is the development of a cadre of teachers and students who have immersed themselves in the culture of another country for the purpose of serving as global leaders in the nursing community. They consistently report the development of a unique perspective informing their health care and educational practices. The graduates of this dual-degree program report the ability to look beyond national borders for solutions to global problems. All of the partners believe that every student in the program benefited from immersion in the culture of health care in another country. All of the partners have data to support that we have prepared bachelor's nurses for work in international environments, not merely taught students to speak the language of patients from other countries. The students participating in the courses gained familiarity with different health care systems, institutions, regulatory environments and teaching methods. The graduates of the dual-degree program mastered competencies facilitating their participation in global programs such as participating in global relief operations, crisis situations and health planning collaborative. Moreover, students have expanded professional and personal relationships beyond geographic boundaries. We anticipate this can have a profound impact on the health care community as the student matures in their career. The recommendations and conclusions of the Bologna Seminar (2004) note that “first degree cycles should encompass general and specific disciplinary knowledge as well as the development of personal qualities including the one of autonomous learner, the capacity to approach new issues, communication skills and other transferable skills. The partners enthusiastically support this recommendation and have gathered data to support its achievement.
The dual-degree program is seamlessly integrated among the institutions. It has been built on the strengths of each partner, Laurea University is known for its programs regarding the improvement of health, Nazareth College is recognized for its expertise in trans-cultural nursing, and Semmelweis is known for its ability to address crisis situations and improve professional competence. The essence of this dual-degree program is that it built on strengths in a manner that did not create a new teaching program but incorporated the already existing and accredited teaching programs into the dual-degree structure.
The faculties involved in the project have visited each other's institutions and have well-established channels of communication. Faculty members will continue to meet in person, regularly, to revise and harmonize existing courses as evidence-based practice in health care mandates. The faculty consult with each other frequently on advisement of students, curriculum and teaching issues. Faculty members involved in the project have participated in lectures, scholarly work and teaching at partner institutions. We have become a cohesive group of colleagues committed to continuing international educational initiatives for many years in the future.
Preliminary findings from the project have been presented at several international forums focusing on global leadership. Memorandums of Understanding have been executed among all of the partners. Every student participating in the program has graduated within four years, has successfully met the requirements for licensure and has begun their careers in a variety of settings.
Private School Without an AHC: Catholic University
Program Description: The Bridge to Practice Clinical Model© (BPM) is an innovative curricular approach to improving the quality of the adult health experience (i.e. medical-surgical) for BSN students. The BPM has been described and an evaluation of its cost-effectiveness is found in Nursing Economics (The Bridge to Practice Model: a collaborative program designed for clinical experiences in baccalaureate nursing. Paterson M, Grandjean C.,Nurs Econ. 2008 Sep-Oct;26(5):302-6, 309). A copy of the Nursing Economics Manuscript describing the BPM and presenting preliminary outcomes is enclosed as a separate document should you desire additional information.
During the medical-surgical clinical courses, students traditionally not only develop specific competencies in direct patient care delivery, but also begin to develop/refine skills related to function on inter-disciplinary teams, begin to understand the cost and quality considerations which influence care delivery and gain an overall appreciation of the context of clinical care. Further, the greatest number of clinical hours in undergraduate nursing is devoted to medical-surgical experiences as opposed to maternal child, pediatrics etc. The setting where students complete their medical-surgical clinical as well as the overall content and structure of the clinical courses then becomes an essential aspect of the educational experience. Schools which are not affiliated with Academic Health Centers have a unique ability and challenge in structuring clinical placements. The BPM model allows students to engage in a variety of clinical experiences at one institution. Over student's four year program of study, the BPM provides 450 hours of clinical experiences (10 academic credits) focused on medical-surgical nursing. These clinical practica progress from Adults in Health and Illness: Basic Clinical Applications, an introductory clinical medical/surgical nursing course, to Medical/Surgical Nursing Leadership, a senior level medical/surgical nursing clinical course taken in the last semester of baccalaureate study. This model, which places the student in one acute care setting for all medical/surgical nursing experiences, combines the best of classroom education and comprehensive hospital-based internships. Students greatly benefit by the strong partnership created between CUA faculty and their hospital-based nurse colleagues to create a supportive environment for clinical instruction in medical/surgical nursing. They have unique clinical experiences structured by the clinical experts who participate in the BPM. For example, a student administering a medication who has questions about dosage may have the opportunity to meet the dispensing pharmacist, and see the pathway from the ordering of the medication, to its dispensing and its administration. As part of the learning environment, students may have the opportunity with few barriers to attend grand rounds, observe surgical procedures, shadow administrators etc. A key aspect of the BPM is that such learning experiences are more readily organized, can be individualized to the student needs, and can vary is scope.
In addition to the benefit to students, the BPM benefits the academic institution by reducing time and costs associated with multiple orientations of faculty and students to medical information systems, HIPAA requirements etc. The institution benefits from the prolonged opportunity to engage with students who may wish to pursue a career at that institution. In addition, the BPM offers economies of scale to participating institutions because of reduction in hospital time for orientation of students and instructors and the associated resource allocation.
Key elements of the BPM related to (a) organizational structure, (b) the nature of clinical supervision, and (c) the relationships between the academic and clinical agency: the clinical agency can elect to have the time of clinical staff assigned to precept a group of students bought out by the SON such that the clinical instructor is an actual staff nurse who currently practices on-site. Alternatively, the SON can directly contract with staff nurses to provide clinical preceptorship. These clinical instructors are supervised by a full-time SON faculty member who is a clinical coordinator for all the medical surgical clinical experiences occurring at that facility. Thus with the BPM, the faculty member is institutionally based further consolidating the relationship between the SON and the clinical agency. The SON faculty member concentrates on one acute care facility and focuses not only on supporting excellence in clinical instruction, but also builds strong relationships with professional nursing colleagues at the facility. This relationship builds mentoring opportunities for the clinical staff, and has increased the interest in clinical teaching among the staff at the participating facilities.
Given the enhanced learning opportunities, students actively participate in the BPM. They apply to enter the BPM, submit a professional resume, and indicate their first, second, and third choice of clinical facility. School of Nursing faculty match students to facilities based on these applications. To increase student exposure to different health care settings so that their perception on health care is not limited by exposure to a single setting or organizational culture, the other clinical experiences (i.e. pediatrics, Maternal/Child, Psych/Mental Health, Community) are completed through other facilities or sites.
Served As A Catalyst For Change Within The Curriculum And/Or Educational Mission Of The Institution: The SON was one of the pilot schools for the Quality and Safety Education for Nurses (QSEN) initiative to improve baccalaureate education. As the BPM was being developed, refined and implemented, QSEN knowledge, skills and attitude competencies were being incorporated within the BPM implementation. Collectively, these two processes provided support for a major curriculum revision in which QSEN competencies were explicitly addressed in the curriculum and the sequencing of medical-surgical course experiences was streamlined to reflect that which would best support the BPM goal to reinforce student learning in medical/surgical nursing by providing continuity in learning experiences across the last 4 semesters of the undergraduate experience.
Potential for Replication/Dissemination: The BPM is suitable for use in other settings and the BPM team have already consulted with other nursing programs. At CUA, the BPM was initially instituted at one clinical agency and now exists at four clinical agencies. One is part of an academic health center, a second a large teaching hospital, the third a military facility and the fourth a large, community based health system.
Involvement of Faculty and Clinical Care Provider Teams: The BPM represents a collaboration between nursing faculty, nurse leaders at participating institutions as well as interdisciplinary teams at participating clinical institutions. The faculty liaison works with the clinical and administrative staff at the participating institutions to develop unique teaching approaches and educational offerings. In the settings where BPM is currently implemented, collaborators have included bedside nurses, nurse educators , nurse administrators, pharmacists, physicians and physiotherapists. The involvement and collaboration is also evident in the conferences/opportunities which the team have developed. These include several poster presentations at national nursing conferences, and publications in nursing economics and education journals.
Consistency with AACN’s Mission and Vision: The AACN and vision address the need to develop nurse leaders who have the ability to collaborate across the disciplines, have a strong understanding of the unique aspects of the nursing role as well as the collaborative role as members of a healthcare team. By fostering education which is responsive to the practice environment and assuring continuity for the student within the complex practice environments in acute care hospitals, the Bridge to Practice is fully consistent with AACN’s mission and vision for nursing in the 21st century.
Advancement of the Profession: An overview of the BPM has been published in Nursing Economics and the BPM has also been presented at national conferences. The profession is advanced by the development of innovative educational approaches which can be translated for use in other practice settings, evaluation of associated outcomes along with a consideration of cost to benefit.
Public School Without an AHC: University of Hawaii - Manoa
Academic Health Center: University of Kentucky
This program is an enrichment experience for selected students who are mentored by faculty researchers on a variety of projects. The goal of the program is to provide students with opportunities to gain an understanding of the basic steps for conducting research and to have hands-on experience working as part of a research team. Sophomore or junior level students with a 3.0 GPA in nursing may participate in the program by registering for NUR 882 Independent Study for one credit hour per semester (4-hour research practicum per week). Interns enroll at least two and up to six semesters. Interested students talk with their academic advisor who helps them find a faculty mentor. The intern and mentor develop a prospectus for each semester to guide the student’s work. Students participate in proposal development; recruitment; data collection, entry, and analysis; manuscript and presentation/poster development for research dissemination; and many other aspects of the research process. All students are required to complete online human subjects training in their first semester. Their work culminates in a final project for which they are recognized at the graduation Pinning Ceremony with a certificate.
Since the inception of the program in 2002, almost 100 students have served as research interns. Currently, there are 20-25 undergraduate students working with about 12-14 different faculty research mentors in any given semester. Most of the research interns matriculate into graduate programs following graduation. Students who participate in the research internship say that it makes research “come alive” for them. The internship supports an important philosophy of learning, “Tell me and I forget; teach me and I may remember; involve me and I will learn” (Benjamin Franklin).
The outcomes of the students have been truly phenomenal. Over the last several years, research interns have developed innovative recruitment strategies, collected air samples, co-authored publications (one was translated into Japanese for circulation to physicians in Japan), received travel grants to present at professional meetings, and won awards for student research posters and podium presentations. Research interns share their research experiences with other nursing students as part of classroom and clinical discussion which has enriched the undergraduate curriculum. This innovative program has been a highly successful and grown tremendously the past seven years. It will continue to have an impact on the careers of the students who participate. As a discipline, nursing is faced with a shortage of faculty and nurse scientists. We know that many of the interns are pursuing graduate education, and the great news is that they are doing it earlier in their careers. Nursing faculty has historically completed doctoral degrees in their 40s. This has resulted in shorter research careers. Consequently, encouraging new graduates to pursue a PhD in their 20s will result in greater research productivity over the course of their careers. The Research Intern Program allows students to develop research skills early in their undergraduate education. Below are examples of just some of the many accomplishments of our Research Interns over the past three to four years (interns in bold face).
Examples of Journal Articles
Roberts, M., Frazier, S., Kelly, S., Sturgeon, L., Wellman, A., Khalil, A., & Hardin-Pierce, M. (2008). The effect of nutritional support on weaning outcome in adult patients receiving mechanical ventilation. American Journal of Critical Care, 17, 276-294.
Hahn, E.J., Rayens, M.K., Butler, K.M., Zhang, M., Durbin, E., & Steinke, D. (2008). Smoke-free laws and adult smoking prevalence. Preventive Medicine, 47(2), 206-209.
Sturgeon, L., Frazier, S., Hardin-Pierce, M., Kelly, S., Khalil, A., Roberts, M., & Wellman, A. (2008). The effect of glycemic control on weaning outcome in adult patients receiving mechanical ventilation. American Journal of Critical Care, 17, 276-294.
Lee, K., Hahn, E.J., Riker, C., Hoehne, A., White, A., Greenwell, D., & Thompson, D. (2007). Secondhand smoke exposure in a rural high school. Journal of School Nursing, 23(4), 222-228.
Burkhart, P.V., Rayens, M.K., Oakley, M.G., Abshire, D.A., & Zhang, M. (2007). Testing an intervention to promote children’s adherence to asthma self-management. Journal of Nursing Scholarship, 39(2), 133-140.
Burkhart, P.V., Rayens, M.K., Revelette, W.R., & Ohlmann, A.B. (2007). Improved health outcomes with peak flow monitoring for children with asthma. Journal of Asthma, 44, 137-142.
Knox, C., & Burkhart, P.V. (2007). Issues related to children’s participation in clinical research. Journal of Pediatric Nursing, 22(4), 310-318.
Burkhart, P.V., & Abshire, D. (2005). Children’s self-reports of physical activity as a trigger for asthma episodes. International Review of Asthma, 7(1), 46-52.
Amshoff, S.K., & Reed, D.B. (2005). Health, work, and safety of farmers ages 50 and older. Geriatric Nursing, 26(5), 304-308.
Examples of National Poster Presentations
Maggie Roberts, Susan Frazier, Sarah Kelly, Lizbeth Sturgeon, Ashley Wellman, Amani Khalil, & Melanie Hardin-Pierce (2008). The Effect of Nutritional Support on Weaning Outcome in Adult Patients Receiving Mechanical Ventilation. American Association of Critical Care Nurses National Teaching Institute.
Liz Sturgeon, Susan Frazier, Melanie Hardin-Pierce, Sarah Kelly, Amani Khalil, Maggie Roberts, & Ashley Wellman (2008). The Effect of Glycemic Control on Weaning Outcome in Adult Patients Receiving Mechanical Ventilation. American Association of Critical Care Nurses National Teaching Institute. Abstract published in American Journal of Critical Care, May 2008, 17, 276-294.
Carol Riker, Kiyoung Lee, Amber Hoehne, Ashleigh White, Devin Greenwell, Dyshel Thompson, & Ellen Hahn (2007). Secondhand Smoke Exposure in a Rural High School. National Conference on Tobacco or Health.
Anne Hickman, Ellen Hahn, Carol Riker, Heather Robertson, Mei Zhang, Kiyoung Lee, & Mark Travers (2007).
Secondhand Smoke Exposure and Alcohol Policy in Urban and Rural Communities. National Conference on Tobacco or Health.
Patricia Burkhart, Mary Kay Rayens, Marsha Oakley, &Ashleigh Ohlmann (2006). Testing an Intervention to Promote Children’s Adherence to Recommended Asthma Self-Management. Sigma Theta Tau International Nursing Research Congress.
Carol Riker, Jan Findlay, & Amber Hoehne (2006). Youth Access Laws and Changes in Sources of Tobacco. Access 2006 Conference.
Posters Presented at the 2009 Southern Nursing Research Society Conference
Brenden Zahn, Kiyoung Lee, Heather Robertson, Laura Whitten, Laura Cole, & Ellen Hahn. Do Enclosed Smoking Areas Protect Nonsmokers and Workers? (Received Second Place in poster contest)
Jessie Bafford, Susan Frazier, Maggie Roberts, Ashely Wellman, Amani Khalil, Liz Sturgeon, Melanie Hardin-Pierce, & Sarah Kelly. Energy Expenditure and Nutritional Adequacy in Patients Receiving Mechanical Ventilation.
Maggie Roberts, Susan Frazier, Lizabeth Sturgeon, Ashley Wellman, Amani Khalil, Melanie Hardin-Pierce, Sarah Kelly, & Jesse Bafford. Frequency and Efficacy of Nutritional Evaluation in Critically Ill Adults Receiving Mechanical Ventilation.
Liz Sturgeon, Susan Frazier, Sarah Kelly, Maggie Roberts, Ashley Wellman, Amani Khalil, Jesse Bafford, & Melanie Hardin-Pierce. Respiratory Muscle Function, Ventilator Weaning Outcome, and Glucose Level in Adult Patients Supported by Mechanical Ventilation.
Posters Presented at the 2008 Southern Nursing Research Society Conference
Emily Durbin, Carol Riker, Ellen Hahn, Sarah Cavendish, Mei Zhang, & Mary Kay Rayens. Leadership and Smoke Free Policy Development.
Page Heller, Carole Haurylko, Deborah Claunch, & Deborah Reed. Injuries to Commercial Truck Drivers.
Janine Lindgreen, Sarah Cavendish, & Ellen Hahn. Monitoring Secular Trends in Community Intervention Studies.
Maggie Roberts, Susan Frazier, Sarah Kelly, Lizbeth Sturgeon, Ashley Wellman, Amani Khalil, & Melanie Hardin-Pierce. The Effect of Nutritional Support on Weaning Outcome in Adult Patients Receiving Mechanical Ventilation.
Liz Sturgeon, Susan Frazier, Melanie Hardin-Pierce, Sarah Kelly, Amani Khalil, Maggie Roberts, & Ashley Wellman. The Effect of Inflammation and Respiratory Muscle Fatigue on Weaning Outcome in Adult Patients Receiving Mechanical Ventilation.
Ashley Wellman & Susan Frazier. Safety Practices Used by Critical Care Nurses in the Care of Patients Receiving Mechanical Ventilation.
Small School: York College of Pennsylvania
In the late 1990’s increased enrollment in the Department of Nursing at York College of Pennsylvania (YCP) created challenges for providing clinical placements. The Community Health Course Coordinator pursued development of a Nurse Managed Center (NMC), the initial intent being to provide appropriate clinical sites to accommodate larger numbers of students in the community health nursing course. Three goals were established:
1. To provide service learning clinical experience where students could meet the community health clinical course objectives
2. To provide wellness services to a medically underserved and economically disadvantaged population
3. To establish a community-campus partnership.
As the NMCs developed these goals were met and many other positive outcomes were also realized.
In early 2000, we entered into a partnership with the York Housing Authority (YHA) to open an NMC in Broad Park Manor (BPM), a complex for low income elderly and disabled individuals. In September 2001, the BPM Wellness Center became operational. Throughout the fall and spring semesters of that academic year, the Wellness Center was open one day per week when the college was in session. Students worked with individuals and aggregates from BPM, providing health assessment and health teaching. The Wellness Center evolved during that first year. The programs and activities were developed by students, with faculty supervision. Students provided individual health assessment and health teaching and carried out aggregate interventions such as blood pressure screening, exercise class and health fairs.
The Wellness Center proved to be an excellent site for students to meet the clinical course objectives. BPM residents were satisfied with the services they received based on findings from client satisfaction surveys. In addition, the partnership between the Nursing Department and the YHA grew strong and positive.
The BPM Wellness Center remained open throughout that first summer staffed by an Advanced Practice Nurse and student externs. Funding for the staffing was through a grant obtained by YHA. The second year, BPM Wellness Center was opened two days per week, providing this excellent clinical learning for even more students and offering more services to the BPM residents.
Because of the success of the BPM Wellness Center, YHA provided space for a Wellness Center to serve residents in other low income housing complexes. This center, the Jefferson Wellness Center, opened in the Fall of 2004. As with the Broad Park Manor Wellness Center, this Center proved to be a valuable clinical learning experience for students while providing health promotion and disease prevention services for low income York City residents. With the opening of this center, we were able to have two thirds of the students in the community health nursing course complete at least a portion of their clinical in a NMC.
The following year, a representative from another housing agency, Delphia Management Corporation, contacted the Course Coordinator requesting similar collaboration. Delphia provides low income housing in York city for a variety of population groups. In the Spring of 2006 the Delphia Wellness Center was opened. The opening of this center allowed sufficient clinical sites for each student in the community health nursing course to have a rotation in one of the NMCs.
Fundraising efforts to staff the NMCs when the college is not in session have been challenging but successful. Each NMC is now open two days per week when the college is in session, and one day per week during college breaks. Remaining open year round improves continuity of care for the residents, provides clinical practice opportunities for faculty and gives students who are particularly interested in community health nursing the opportunity for additional clinical experience as paid student nurse externs.
The campus-community partnership is strong with both the YHA and the Delphia Management Corporation. We’ve collaborated with other service providers including the York City Health Bureau to provide influenza immunizations, and numerous agencies to conduct health fairs and screenings.
The NMCs were the focus of a public relations campaign conducted by the College. A radio advertisement highlighting the unique service learning opportunity for students launched additional interest that resulted in a television advertisement. Newspaper articles in the local paper have included photos and coverage of health fairs, immunization clinics and even one feature on a pet therapy intervention. Such positive public relations have benefited both the college and our community partners.
YCP have obtained funding for special programs, such as an Asthma Safe Kids program that provides in home teaching for caregivers of children with asthma. Students who conducted these visits collaborated with faculty in research data collection and in presenting findings.
Interdisciplinary collaboration with other Departments in the college has also occurred. Students in a Graphic Arts Design course developed our NMC logo. Students in a Grant Writing course have written grant proposals. Students in a Social Aspects of Aging course have collaborated with faculty in the Behavioral Science Department conducting an Oral History Project research study.
The clinical experience that our students have received in the NMCs has been remarkable. Our initial goal was that the students would be able to meet the clinical course objectives, but students have expressed learning that goes beyond those objectives. In the NMCs students are able to have continuous client contact, allowing them to establish therapeutic nurse client relationship in ways they have not previously experienced. Based on student feedback regarding the value of this experience, students are now in the NMC for clinical for an entire semester, rather than for a half semester rotation.
Despite efforts to increase the diversity of the student population at York College we continue to have a homogenous student population of white, middle class, traditional college students. This clinical experience with low income clients is a cross cultural experience for our students. Through working at the NMCs, students see differences in quality of care from what they are accustomed to. They see the hardships that low income individuals face and articulate how it will change the way they view patients in any setting.
During the first year of operation, 382 client encounters were documented. Last year, we had over 2500 client encounters between our nursing students and low income York city residents.
Private School Without an AHC: Pace University
With the assistance of a visiting scholar, consultants, and external funding, and extensive faculty development, LSN faculty was able to fully integrate evidence-based practice (EBP) into undergraduate and graduate curricula and develop rich community partnerships. Outcomes include: increased student satisfaction; greater interest in and valuing research; closer linkages among courses; increased clinical partnerships for research and EBP projects (with some leading to Magnet Recognition); and numerous presentations, publications, and other scholarly outcomes.
Description of the Programmatic Innovation
The Lienhard School of Nursing has successfully integrated the concepts and processes of evidence-based practice (EBP) into undergraduate, master’s, and doctoral level curricula, and extended this expertise to a number of clinical partners. Important to note is 8 years ago the term “EBP” was being discussed by few faculty and taught as one lecture in one course; yet EBP is now a major concept in the organizing framework of curricula for all programs. The processes and approaches used for faculty and curriculum development, research on EBP approaches to practice, and dissemination and integration of this decision-making framework for practice improvement in our clinical agencies will be discussed below. In addition, we describe outcomes of this programmatic innovation.
In 2001 the Lienhard School of Nursing (LSN) hired a visiting scholar (VS) whose area of expertise was research and research utilization. She had taught research from a utilization perspective for many years. At one point during her time as VS, she assumed the responsibility of teaching the master’s level research course. At that time, the VS held the position of chair of the New York State Nurses Association (NYSNA) Council on Nursing Research. This Council had developed a Nursing Research Agenda for NY State, which included dissemination of research findings for use in practice and developing an infrastructure to support research utilization. Simultaneously, the VS began work with an expert in EBP to develop a research proposal that focused on a strategy for advancing EBP in the clinical setting. Their work was in collaboration with NYSNA and the Foundation of New York State Nurses, with LSN fast becoming a major player.
Subsequent faculty attendance at EBP conferences at the University of Rochester and consultation from the EBP expert about integrating EBP into the graduate curriculum further expanded faculty knowledge about EBP. These initial activities also led to the first change: revamping the master’s level research course to be taught from an EBP framework. The following semester faculty began to teach the master’s research course from an EBP perspective. Students’ evaluations of the course were positive and they began to see the value of nursing research for practice. At curriculum meetings throughout the year, the faculty deliberated many issues related to the amount of research needed in the curriculum and how to integrate EBP in the research course and others.
At the same time, the School received external funding to support a four pronged approach to moving our EBP agenda forward: Faculty Development, Curriculum Development, Research, and Dissemination to Clinical Partners. A 2-year grant from the Hugoton Foundation paid 50% of the time of the VS to be project director. This laid the groundwork for what was to come.
The VS appointment included teaching undergraduate research courses, which provided an opportunity to move forward the integration of EBP. To accomplish this, the VS initially mentored the faculty member who generally taught the undergraduate research courses. Thus, the revision process began by using an EBP framework in that course. Subsequently, other faculty were mentored to teach this course, working collaboratively to continue course revisions and enhancements. Following acceptance by faculty of the revised undergraduate and graduate research courses, and with the help of the Hugoton Foundation grant, faculty participated in presentations on EBP at regularly scheduled LSN Scholarly Colloquia programs and Brown Bag Teaching Forums, specifically designed workshops for clinical faculty, and new faculty orientation meetings. In addition the VS presented guest lectures in many undergraduate and graduate courses and worked with individual faculty to design EBP learning activities in clinical courses. After the funding period ended, additional funding was provided by alumnus and member of the LSN Advisory Board to continue this work. A year-long “Scholarship Development Series,” led by the VS and lead FNP faculty member, was held for a group of research-active faculty, with periodic meetings of a dean-led support group to discuss progress and identify additional resources to move forward their scholarship.
The undergraduate research courses for basic and career change programs were just the beginning. By working closely with faculty teaching clinical courses to use an EBP approach, we were able to level and integrate EBP in these courses. Faculty development activities facilitated integration of EBP concepts and processes into the graduate level as well, beginning with the FNP Master’s Program, where the entire curriculum was revised using an EBP framework. The lead FNP faculty member, with the aid of an external consultant and the VS, revised all FNP clinical courses using an EBP framework. The changes were implemented in 2004, and in January 2006 the first group of FNPs completed the new EBP curriculum. In core courses, students learn about EBP as a decision-making model and practice improvement strategy. They use this foundation in clinical courses, where faculty act as EBP mentors to evaluate evidence and the application of the evidence to clinical practice. The FNP clinical capstone course requires students to complete a project where they put evidence into practice. In the spirit of EBP, identifying curriculum outcomes of this innovation became even more essential. We therefore looked at changes over time, from when students began their clinical FNP courses, as measured by the EBP Beliefs Scale and the EBP Implementation Scale (Melnyk and Fineout-Overholt) to program completion. Recent data show significant positive gains in our FNP students’ EBP beliefs and implementation behaviors.
This foundation in EBP has enhanced curriculum development in the FNP program. Building on the master’s FNP curriculum, the newly initiated DNP program has a firm foundation in EBP, as well as primary health care and cultural competence. With the expertise and guidance of DNP faculty, students are challenged to consider and address the importance of differences in ethnic and racial factors when looking at patient and provider perspectives in implementing EBP.
Research and Dissemination to Clinical Partners
Hugoton Foundation funding also supported a feasibility study of methods to integrate EBP into the clinical setting, starting with the Hospital for Special Surgery (HSS) in New York City. This resulted in a pilot study of a mentoring model for integrating EBP into clinical agencies: “Advancing Research and Clinical Practice Through Close Collaboration (ARCC): A Pilot Test of an Intervention to Improve Evidence-Based Care and Patient Outcomes in a Community Health Setting,” and a published article (Journal of the NYSNA). Next, the VS implemented a similar project with the Visiting Nurse Service of New York (VNSNY), resulting in an international presentation and published article (in JPN). Currently, other partners are working with LSN faculty to advance EBP. Further presentations and publications are planned outcomes.
How were Award Criteria Met?
Served as a catalyst for change within the curriculum and/or educational mission of the institution
Was sustained for at least one year and has achieved desired outcomes
Has the potential for replication and dissemination
Has involved teams of faculty when possible (e.g., across programs, disciplines)
Is consistent with AACN’s mission and vision
Demonstrates advancement of professional nursing education
Criteria 1, 3, 4, and 6: The EBP work was clearly a catalyst for change in curriculum, faculty, clinical partners, and the profession at large. The more than 50 external presentations, publications (including a textbook, Teaching Evidence-Based Practice in Nursing: A Guide for Academic and Clinical Settings in 2006 and a regular column in the journalResearch and Theory in Nursing Practice), and consultations (most notably with the NYU Hartford Institute for Geriatric Nursing to revise their literature to reflect EBP) has been most rewarding as EBP information is disseminated within the field of nursing education and practice.
Criterion 2: The timeline and trajectory described above clearly demonstrate that this innovation has been sustained far beyond 1 year and that numerous positive outcomes were and continue to be achieved. EBP is integrated into all LSN, and is being integrated with at least four clinical partners, a true cultural transformation for them. Another outgrowth of the EBP work was that the principal proponents of the change have held shared appointments with various clinical partners to introduce and expand EBP in these clinical settings.
Criterion 5: The LSN innovation is wholly consistent with the mission of AACN, which includes “[serving] the public interest by providing standards and resources and fostering innovation to advance professional nursing education, research, and practice.” Further, the vision is supported in that we are preparing highly educated professional nurses “to improve health and the delivery of care services” and, at the same time increasing the ability of the current workforce to deliver this care.
Public School Without an AHC: Rhode Island College
Nurses have the potential to promote the public’s health through active involvement in shaping health and social policy. For the past several years, an innovative series of active learning experiences has been implemented in the public health nursing curriculum designed to provide senior nursing students with the political perspective as well as the knowledge, skills, and tools needed to influence public health policy. The public policy learning activities are a vital clinical component and supported by theoretical content. This assignment has evolved into an innovative capstone project, resulting in positive student outcomes.
Description of the Innovation: First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators’ interest and commitment to health related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens.
At the beginning of the semester, students attend information sessions and tours of the Rhode Island Department of Health (RIDOH) and State House. These sessions lay the groundwork for the subsequent learning experiences, a legislative assignment and a public policy group project. During the RIDOH Information Sessions, public health professionals present interactive sessions concerning health department programs.
The State House session provides students the opportunity to experience the political process in action. Even though Rhode Island is a small state (i.e., 48 miles from north to south and 37 miles from east to west) and the state capital of Providence is centrally located, many students have not been to the State House since a grade school field trip and some, especially immigrant students, have never visited the State House. Participants include the Lieutenant Governor, State senators and representatives, the director of the Rhode Island State Nurses Association, a spokesperson from the Rhode Island Public Health Association, the RIDOH legislative liaison, and community activists. Presenters enthusiastically share their belief in the significance of involvement in the political process. Political leaders convey that they respect the nursing profession and value the participation of nurses in the political process.
Presenters identify and discuss current health-related legislative issues, providing students with helpful ideas for their public policy topics. Students are informed about the three branches of government, how an idea for a law is drafted into a bill, how a bill becomes a law, the importance of voting, the concept of lobbying, and how to testify at public hearings. Community advocates discuss the principles of organizing and the importance of telephoning, e-mailing, and writing letters to legislators concerning issues. Participants encourage the students to view the State House as “your house” and encourage them to return for activities such as testifying at public hearings. Students observe activities such as public hearings, demonstrations, and advocacy group meetings during our visit. During the RIDOH and State House sessions students gain the beginning knowledge, tools, and enthusiasm for the subsequent learning experiences, designed to engage them in influencing public policy.
In the legislative assignment, using the General Assembly Web site, students identify their State representative and senator, print copies of their “Legislative Biographies, and review the listings of bills sponsored by each legislator. Students then distinguish any health bills and issues of interest, and from this information analyze the degree to which their legislators have health issues among their legislative priorities. Students are required to compose and send an e-mail message regarding a health issue including a question that necessitates a response to one of their legislators. After completing this assignment, students who were previously unable to even identify their legislators, are able to assess the degree to which they are satisfied with their legislators’ commitment to health-related issues. Through use of the General Assembly web site, students become familiar with information technology that facilitates their future, informed engagement in the political process.
Through the public policy group project, it is hoped that students will realize the significance of the public policy process in promoting the health of populations and become engaged in this process. At the start of this semester-long project, each clinical group organizes to explore a health issue that has public policy implications. Students brainstorm and identify public health problems and come to a consensus regarding a health problem of concern to the community. They also attend to group process issues such as choosing a leader and organizing the group to complete the assignment. Next, students conduct an in-depth analysis of the public health problem and develop a plan for addressing the issue. Each member gathers specific assessment data. This includes library and Internet research and interviews with key people who are involved with the issue. Students articulate the problem into a community diagnosis, and identify and analyze public policy initiatives that will address the problem.
Finally, the group prepares a Power Point presentation that communicates this process. On-campus presentations are conducted in a technology-equipped room and members of the college community, alumni, as well as members of the Rhode Island community especially those involved with the issues are invited to attend. Nursing faculty and their clinical groups from all levels and specialties attend the presentations and participate in the subsequent discussions.
A professional conference atmosphere is promoted. A brochure lists the title of each group’s presentation and the members of each clinical group. Examples of public policy topics include gang violence, childhood obesity, lead poisoning, under age drinking, smoking in public places, fuel poverty, and window safety guards. Following the public policy presentations, each student writes a brief paper, evaluating the group’s process over the course of the semester.
Outcomes: The public policy learning experiences are evaluated through a tool, rubrics, qualitative feedback from students and faculty and more recently, a survey of students and the addition of items on the annual survey of graduates to assess involvement in advocacy and political activities. Through these learning experiences students gain a practical understanding of the political process and the knowledge, skills, and tools needed to influence public health policy. They dialogue with public health leaders, community activists, and legislators; identify and contact their legislators and learn to use Internet-based legislative tracking programs; and analyze a health issue and related policy initiatives. Qualitatively, students express disappointment when their legislators do not respond to them. Many students remarked that they now realize the significance of public policy to nursing. “I learned how legislation and nursing are connected,” and “I think it is important to understand the governmental process and how this affects health. This assignment gave me insight into public policies.”
Student outcomes include increased knowledge of the political process, the belief that advocacy can lead to important political change, and engagement in the political process. Perhaps most importantly, students realize the potential of the voice of nursing in public policy. As one student wrote, “I learned that our voices are important, and thus as nurses, we can make a difference.” Students comment on how the project has helped them learn group process, teamwork, and organizational skills. One student captured the essence of the group process when she wrote, “With this group it was the journey, not the destination that was complicated.”
Currently, the project is being evaluated with a “Political Astuteness Survey” administered prior to and at the completion of the series of assignments. Preliminary analysis indicates that most students move from the levels of “totally unaware” or “slightly more aware of politics on nursing” to “beginning political astuteness” with a few rising to the level “politically astute, asset to nursing.” Anecdotally, our graduates have testified at public hearings, led community and professional organizations, and established the Rhode Island Black Nurses Association and Rhode Island Hispanic Nurses Association.
The Project’s Relationship to Award Criteria: The project has helped to promote change within the nursing program, the College, and the community. The nursing faculty and students as a whole have become increasingly enthusiastic about the project. Students and faculty from other disciplines attend the presentations. The presentations have also been a part of the College-wide weeklong “Convocation of Scholars” program during which faculty and students present their scholarly work.
Through interactions with students and faculty during these learning activities, politicians, stakeholders, and others who may have a narrow view of nursing have been enlightened about the social responsibility of nurses to promote and protect the health of the public. Perhaps most significantly, our students have successfully advocated for health policies that promote the health of the community, such as prohibiting utility shut-offs for families with infants, prohibiting smoking in public places, and lead hazard-reduction.
It might be challenging to implement the project in larger states, with a greater distance to the state capital. However, it is adaptable to city and town governments. Currently, much of the information needed to implement the project is available through state legislative web sites.
Successful efforts to disseminate descriptions of the public policy learning activities and their associated outcomes, as well as their evolution over time continue with presentations at the American Public Health Association annual meetings and publications in professional journals.
Preparing nursing students to influence public policy with the goal of improving population health is a critical component of nursing education. Two of the nine “essentials” of The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008), are directly related to this critical component. Both Essential V (Healthcare Policy, Finance, and Regulatory Environments) and Essential VII (Clinical Prevention and Population Health for Optimizing Health) address this increasingly critical aspect of nursing education.
Academic Health Center: University of New Mexico
Small School: College of St. Scholastica
In response to calls from the Pew Commission and the Institute of Medicine to enhance patient safety via information technology, faculty at the College of St. Scholastica School of Nursing formed a partnership with the school’s Health Information Management department and the Cerner Corporation to create an innovative teaching learning tool with the power to engage students with real patients in discovery of the essentials of nursing. In 2002 this partnership secured federal funding which set in motion the Advancing Technology in Health Science Education Now at St. Scholastica (ATHENS) program. The primary goal of ATHENS was to increase the decision-making and practice competence of graduates by providing them with the tools to access patient data and best practices guidelines at the point-of-care. Project objectives were to increase the use of clinical information systems in the curricula through the use of increased hands-on technology applications and to increase the faculty use of computer-based clinical simulation experiences as a means to assess student decision-making and problem–solving. Because local clinical facilities were reticent to share patient records due to privacy issues, faculty and staff solicited “donors”. These 40 cases are actual clinical cases that alumni, faculty, students, or family members have consented to have replicated in an electronic format. Further, culturally diverse cases have been secured which are useful in a largely Scandinavian rural region. Culturally sensitive care information is embedded in the tool.
Consider the case of Mrs. F. Pristine, who is an actual 47 year old married female, mother of two young daughters, and the family’s primary bread-winner. Students are able to access her case, which carries the patient from her diagnosis with acute lymphocytic leukemia, initial chemotherapy throughout six weeks of hospitalization. Beginning nursing students simultaneously learn how to perform a head to toe assessment in the laboratory setting while learning to chart their findings within the electronic health record system. The activity of preplanning for clinical activities can also be taught to sophomores by utilizing this case and perhaps focusing class discussions on formulating a holistic psychosocial plan of care for the client. Juniors are challenged to access the case of Mrs. Pristine while engaging in simulated patient care. In this situation, a high fidelity human patient simulator presents with the same essential patient data Mrs. Pristine exhibits on the day that her central venous access device is inserted to deliver her chemotherapy. However, in the simulation exercise, the client experiences a pneumothorax during the insertion, which students are challenged to detect and treat effectively. Seniors and post-baccalaureate nursing programs access the electronic health record of Mrs. Pristine via personal laptop computers in the classroom as they learn the theoretical essentials of cancer care. While learning about the impact of chemotherapy on lab values, nutrition and particular body systems, they view the data in the chart which shows these anticipated responses and trends over time. By reading the multidisciplinary notes contributed by the social worker, chaplain, dietician, physicians and each nurse that cared for the patient, students are able to assess the complex needs related to financial burdens, role changes, fear of death, and physical changes that cancer can cause.
Students are encouraged to access an array of reference resources embedded within the ATHENS system at this point of inquiry. References include evidence-based practice guidelines, standards of practice, cultural references, laboratory values/diagnostic procedure descriptions and norms, and medication resources. Clinical nurse specialist graduate students use the same case as a basis for learning the consulting process.
To sustain this project into the future post funding, The Center for Healthcare Innovation at The College of St. Scholastica has made this tool available on a subscription basis to other colleges and universities at a greatly reduced cost. Replicating the development of this tool would require the same intensive funding secured through the federal grant. Currently, 26 colleges and universities use the academic electronic health records (AEHR) system through this service. As the prevalence of health information technology expands, the AEHR will be a creative teaching tool for the preparation of a nursing workforce that is capable of innovation, high levels of critical thinking and problem solving.
Private School Without an AHC: Shenandoah University
In January 2005, faculty in the Division of Nursing at Shenandoah University attended the RN Readiness Summit held at George Mason University. The question posed over the course of the two-day conference was how well is nursing prepared for a disaster event should one occur. Disaster events may occur anywhere in this country or the world as a result of natural or manmade events, terrorism, or bioterrorism, or extremes in weather conditions. Attendees were also asked “where nursing students were getting this content in their curriculums”.
Following the conference, our faculty reflected first on how important it would be to integrate this content into the current curriculum and as soon as possible. After an evaluation of the curriculum, courses were rearranged to make accommodations for a new 3 credits, senior level, emergency preparedness and disaster nursing course. The course was designed to run concurrently with the community course and clinical. A similar course at the graduate level was also developed. These courses were first implemented in the fall of 2005. Examples of course content areas include: types of disasters; role of the nurse in disaster; disaster management agencies and organizations; planning for disasters; stages of disaster; patient tracking systems; mass casualty care and triage; crisis communication and communication with the media; special and vulnerable populations; care of children in disaster; ethical, legal and moral issues; infection control and emerging infections; bioterrorism, radiation incidents, environmental disasters, chemical agents and decontamination.
Learning activities for the course include the viewing and discussion of videos such as Influenza 1918: The worse epidemic in America, Secrets of the dead: Killer flu, and Hurricane Katrina: The storm that drowned a city. Regularly invited guest speakers for the course include: the Emergency Planner of the Virginia Department of Health for the local region; an infection control nurse who cared for the first SARS patient in Loudoun County, Virginia; a local nurse with a wide range of experiences related to emergency department management, military experience, and trauma director presents on triage and mass casualty; and the local fire and rescue departments present as well and demonstrate their decontamination techniques and equipment. Students have been involved in a variety of table top exercises as well as disaster drill involving the community, local fire and rescue, hospitals, and evaluated by the Department of Homeland Security.
Students additionally take online the National Incident Management System course, IS 700, and IS 100 for Healthcare providers. These courses are offered free of charge through the Federal Emergency Management web site. Participating students receive a certificate of completion for their portfolios. Students are given the option to complete the course on the National Response Plan at the same web site for extra credit.
Following the Katrina Hurricane disaster, the faculty became aware after a series of inquiries that the faculty and students would be unable to volunteer without the proper training and certification from the American Red Cross (ARC). Faculty followed up by contacting the local Frederick County Chapter, exploring the possibility of organizing training classes that would facilitate our faculty and students to be prepared to participate in any future disaster event if needed. In late fall 2005, this chapter of the ARC, under the direction of Mrs. Tootie Campbell, set up a one day training class for students which is now offered each semester. It has become a requirement as part of the student’s community class and nursing disaster class that they must complete this curse. Since fall 2005, students have consistently received this class for 6 consecutive semesters; approximately 275 students. The students receive cards certifying completion and affords them the opportunity to volunteer for the American Red Cross anywhere in the country.
Finally, assignments for the course have included written exams and a variety of research assignments. Students have analyzed and critiqued disaster plans from a variety of institutions, developed pandemic plans, critiqued pandemic questions for various groups, and most recently, developed personal/ family disaster preparedness plans. The goal of this most recent assignments was to self reflect on preparedness and readiness of the newly licensed RN for a possible disaster event since most nurses would likely be called early to respond to a disaster.
As a result of this course, which has been consistently offered for the past 6 semesters and continues to be offered, our Division of Nursing are preparing clinicians who will have a basic knowledge and competencies of disaster nursing. They have learned the importance of collaboration with other agencies in disaster planning, such as their local health departments, hospitals, fire and rescue, American Red Cross, and many others. These nursing students will graduate and will be “key players in the local and national emergency response as we move through the 21st century” (Gebbie & Qureeshi, 2006).
Public School Without an AHC: University of North Florida
Recognizing the need for innovation, the University of North Florida School of Nursing refined the baccalaureate curriculum to enhance the preparation of future nurses with quality, relevant education. Past experiences had shown that students struggled with the community concepts, particularly when they were exposed to these concepts during their last semester, and were expected to produce worthwhile significant projects while they were focusing on their capstone course. A particular challenge was to assist students to see their current acute care, disease oriented relationship with patients could be enhanced by a more holistic approach as offered from the community health perspective.
The development of the new curriculum required an incredible amount of time from faculty who were already stretched thin. Regardless, faculty were willing to come together in multiple faculty retreats to address the problem, voice their concerns and those of their students, and identify a solution. The top concerns expressed were: 1) how to continue to assure a high level of technical and critical care skills for acute care practice; 2) how to maintain the high NCLEX pass rate; 3) how to transfer the learned acute care skills to the community setting. As a solution, the School of Nursing sent a small group of faculty would attend an AACN conference with a primary goal in mind: returning with a curriculum plan. In addition, a consultant from a fellow Florida school was engaged and other models of Community Based Nursing Education were explored.
Upon returning energized and with viable ideas, the Dean, Director and faculty created a new curriculum, which was implemented in Summer 2001. The emphasis was on community nursing, understanding that this not only provided the students invaluable, transformational learning opportunities, but it gave the faculty and students a chance to serve the community as well. Two community nursing didactic courses were developed. During the first semester, students take a four credit Family and Community assessment course that teaches basic concepts and fosters home-base familiarization; in the last semester, students take a five credit Community Partnerships course which is population-focused and teaches more advanced public health theory and concepts. In addition to the didactic and clinical continuity, there is continuity in community-building within the students and community partners. Through meetings and group work, students come together from different levels and develop a sense of community around a shared home-base. They support and mentor each other. In addition, the students had community practice hours every semester. Clinical hours dedicated to home-base activities range from 12 to 17 per semester for the first four semesters. In the final semester students design and implement major projects during a 90-hour community capstone experience.
Since the implementation of the new curriculum, we have followed a continuous process improvement format: Plan, Do, Check, Act. We continued to refine the program through the use of focus groups, exit surveys, student responses and journal reviews until we came up with our current model. The SON had developed a program which is unique to UNF and unlike any other program in the nation. The University reviewed and evaluated the program and consequently named the SON community-based curriculum the first flagship program for the University and primed for national excellence and recognition.
The refined curriculum was accomplished within the same number of credit hours as the previous curriculum without compromising the excellent education UNF nursing students and employers of UNF graduates expect. The SON successfully managed to implement this curriculum and maintained excellence in the graduates’ ability to perform positively on NCLEX. This aspect was of particular concern - and subsequently pride - to faculty.
The curriculum refinement evolved into the UNF Community Home-base model with continuous feedback from students, faculty, and community stakeholders. The Home-base model provides the students with a concentrated longitudinal experience over the course of their nursing program in one particular community or home-base. A home-base is a community-campus partnership which may be geographically or agency based. This home-base is composed of multiple community/agency partners, two faculty leaders and up to 48 students. Agency partners include: American Red Cross, schools, community health centers, senior citizen centers, neighborhood centers, homeless shelters, and other agencies in Northeast Florida. Six home-base community-campus partnerships involve 12-14 faculty regardless of specialization, several hundred nursing students from all levels in the program and community partners who work in teams to assure sustainability in long-term service learning projects to meet community priorities. Each home-base consists of multiple partnerships with community agencies/neighborhoods linked by a geographic or program focus that are coordinated by a two-person faculty team.
Outcomes of the program included:
Students across the home-base observe role modeling of faculty in the community and have the opportunity to develop partnership skills.
Students become invested, share ownership and challenge faculty to assure sustainability of their efforts.
Students share recognition by being featured in print and television media for their contributions to the community, co-presenting at professional conferences and receiving national awards.
47% of exiting students report they would “very likely/somewhat likely” consider a future career in community/public health nursing.
90% of exiting students report supporting the SON community curriculum.
Faculty has secured participatory grants shared with community partners.
Receipt of advocacy and service awards has distinguished the SON and UNF.
Faculty enjoy the long-term mentoring relationship with a cohort of students.
Community agency partners benefit from over 250 service-learning projects performed over a seven-year period, which increased agency capacity.
Partners participation in continuing education retreats with faculty.
Faculty participate in many local non-governmental organization boards/committees.
This programmatic innovation meets all the identified criteria for the Innovations in Professional Nursing Education Award. Sustainability is expected and fully supported by the University. The SON has served as a model for service learning within the University and was a catalyst for change as Community-based Learning and Community Involvement was incorporated into the University’s Quality Enhancement Plan. The curriculum was implemented in 2001 and continues to be strengthened through the support of faculty and community partners. The program involves all faculty, either directly or indirectly, and all have had input into the development and fine-tuning of the program. At least 14 faculty members are actively involved in home-base activities, while the remaining faculty members support these activities. Additionally, the program has potential for replication and other Universities have already asked for ideas on how to implement similar programs into their curriculum.