2010 Innovations in Professional Nursing Education Award Winners
Academic Health Center: University of Maryland
Small School: Nazareth College
Private School Without an AHC: Catholic University
Public School Without an AHC: University of Hawaii - Manoa
Past Award Winners
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.
Assessment. 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.
Evaluation: 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.
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 collaboratives. 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.
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.
University of Hawaii - Manoa - Winner, Public School Without an AHC