2008 Innovations in Professional Nursing Education Award Winners
Academic Health Center: University of New Mexico
Small School: College of St. Scholastica
Private School Without an AHC: Shenandoah University
Public School Without an AHC: University of North Florida
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.
College of St. Scholastica
Winner - Small School Category
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.
Winner - Private School Without an AHC Category
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).
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:
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.