AACN - Innovations Award

This award recognizes the outstanding work of AACN member schools to re-envision traditional models for nursing education and lead programmatic change. Innovation awards, including a monetary prize of $1,000, will be given annually in four institutional categories: Small School; Academic Health Center (AHC); Private School without an AHC; and Public School without an AHC. In terms of award criteria, schools submitting nominations were ask to show that the programmatic innovation:

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.

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

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.

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.

Faculty Development
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.

Curriculum Development
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.

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.

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
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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.

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.

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).

University of North Florida - Winner, Public School Without an AHC Category

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.