2012 Innovations in Professional Nursing Education Award Winners
Academic Health Centers: The University of Texas Medical Branch at Galveston
Small Schools: Misericordia University
Private Schools Without an AHC: Lourdes University College of Nursing
- Public School Without an AHC: Kent State University
The University of Texas Medical Branch at Galveston
Winner - Academic Health Centers
Three outcome objectives were accomplished through this project. The first objective was the development of an Electronic Statewide Distance Training Program (Court Visitor Program or CVP). This program was designed to provide training for undergraduate nursing students as Court Visitors, for the purpose of making annual visits to Wards (legally) incapacitated on behalf of the Texas Probate Courts and to monitor quality of care provided by their guardian. The online program consisted of 12 modules containing nursing and legal theory relevant to Court Visitor functions with pre and posttest and a final exam over all content.
The second objective was the implementation of an Electronic Statewide Court Visitor Program within the clinical portions of undergraduate nursing courses, such as psychiatric and/or community health nursing. Ten (10) probate court jurisdictions were targeted for inclusion in the Project. The CVP has been implemented in four (4) counties encompassing five (5) schools of nursing, two (2) schools of medicine, and one (1) school of physical therapy. It is projected that in 2012-2013 the CVP will be expanded and implemented in five (5) additional counties encompassing four (4) schools of nursing and one (1) Texas administrative agency (Department of Aging and Disability located in Cameron County).
The third objective of the project was the evaluation of the Electronic Statewide Court Visitor Program. The evaluation was conducted to ensure the infrastructure to support the availability and sustainability of a full range of healthcare skills and services to Wards, eliminate health disparities and assure quality of care. One thousand and eighty (1080) Wards & one hundred and eighty (180) nursing students were targeted for inclusion in the project. To date, approximately 300 nursing, medical and physical therapy students have made annual visits to over 800 Wards of the Court, filing Guardianship Court Visitor Reports describing quality of and access to care. Further, CVP training has been provided to dozens of nursing faculty and court personnel.
The Court Visitor Program (CVP) was funded by the Health Resources and Services Administration (HRSA) for the period of 2009-2012, for the purpose of implementing the CVP statewide. This program would facilitate the Wards’ access to quality care across the State of Texas. There are approximately 20,000 Wards of the Court and 20 Court investigators, who must monitor annually the quality of care provided to the Wards by the guardians. In response to this imbalance of 1000:1 and Texas Statutory Law, the Court Visitor Program was established in Galveston County in 2001, in collaboration with UTMB School of Nursing, via the clinical of an undergraduate psychiatric course, to assist the Court with these annual visits. In summary, within the CVP, the Probate Courts are utilized as clinical sites, and pairs of students make visits to the incapacitated at their place of residence.
Meeting the Award Criteria
The CVP Model has served as a catalyst for change within the curriculum and/or educational mission of each of the institutions in which it has been implemented. One of the most significant changes was in the area of forensic involvement and expansion. Included within this change was the expansion to an interdisciplinary team that included nursing, medical and physical therapy students and, the addition of a pilot program using the CVP model in the undergraduate pediatric nursing clinical experience which will serve as the basis for the development of a HRSA grant focusing on a statewide pediatric assessment project and its use of the established CVP sites.
The CVP model has broad implications and serves as a basis for the development and addition of a pain management project, the expansion of the community health experience to work with criminal courts that are providing rehabilitation services of individuals with driving under the influence (DUI) offenses. Each of the sites is currently involved in collaborating with Dr. O’Keefe in the development of a publication. The site faculty provides the scholarly focus and Dr. O’Keefe provides the data analysis and interpretation. Finally, Dr. O’Keefe has actively involved nursing PhD students in data analysis for publications.
The CVP has been very successful mainly because of the ease of replication and online dissemination. The CVP is flexible so that all aspects of the training program and Report to the Court may be easily adapted to meet the academic needs of the School of Nursing and the evidentiary needs of the probate Courts. Over the 2 ½ year period of the project, each clinical site has become self-sustaining, as once a trainer is provided, the collaboration is established with the Court, and students enroll in the online training program, the involvement with Dr. O’Keefe becomes minimal and typically includes only sharing of data analysis.
The development and implementation of the CVP has involved teams of experts across the nursing, medical, allied health & legal professions. Not only are the disciplines of law, nursing and medicine involved in the delivery of care, but also teams of social and community health workers, court investigators and American Association of Retired Persons volunteers participate in this interdisciplinary team.
The CVP is consistent with the mission of the American Association of Colleges of Nursing (AACN), as this service learning project addresses the public interest of providing quality care to a vulnerable population by monitoring the standard of care provided by the guardians, providing nursing students as resources to monitor that care, and developing the leadership capacity of The University of Texas Medical Branch School of Nursing to advance nursing education at School’s of Nursing around the state of Texas, provide research experience for Advanced practice nursing students, and provide a clinical practice site for undergraduate students.
Additionally, The CVP provides training for highly educated trainers and diverse undergraduate nursing students to lead the delivery of quality health care to a vulnerable population and the generation of new knowledge to improve health and the delivery of care services to the incapacitated.
This project has demonstrated advancement of professional nursing education through achievement of AACN Goal 1 which addresses providing strategic leadership that advances professional nursing education, research and practice. The project has led to innovations in baccalaureate and graduate nursing education (noted previously) that have promoted high quality health care for the incapacitated and is providing new knowledge generation for ongoing program revisions. In addition the implementation of the project has enabled the establishment of collaborative relationships and formed strategic alliances between Schools of Nursing across the State of Texas, to advance baccalaureate nursing education. And finally the project’s visibility and success has increased the visibility and participation of nursing's academic leaders in each site and promoted the vision and mission of advocating for innovation in nursing education.
This innovative project has been very successful and has provided a variety of learning experiences for students. It is because of the creativity of this project and its successful implementation that I sincerely hope that the committee will review this innovation favorably.
Winner - Small Schools
During the academic year of 2009 an IPE coalition (NEPA-IPEC) was formed which consisted of 12 multidisciplinary programs par¬ticipating in interprofessional activities in Northeast¬ern Pennsylvania. The goal of NEPA-IPEC was to hold collaborative activities to serve as forums to share and exchange interprofessional experiences. The first twoIPE activities had more than 100 multidisci¬plinary students participating at three designated sites throughout the Commonwealth.
This is an example of the first IPE activity that was presented. At the beginning of the program, students were gath¬ered in the auditorium. A speaker presented informa¬tion related to the goals for this experience and gave information related to IPE. The group viewed a video which showed a disheveled man who was confused and unable to communicate to staff when presenting at the emergency room carrying a bag of medication. Stu¬dents then broke into groups of 10, having two facilita¬tors from different disciples to lead the discussion. Ice breakers and introductions were used to identify the disciples in each group. Students were asked to dis¬cuss considerations for the care of this gentleman from various perspectives (i.e., physical therapy, speech medical student, physician assistant, nursing, social work, anesthesia and advance practice nursing). One Misericordia University was a key player and provided the venue for the first IPE summit. These types of summits can be used as a mechanism to have students from multiple disciplines explore ethical is¬sues, define professional roles and responsibilities, promote interdisciplinary communication through teamwork and collaboration which are consistent with the core competencies for Inter-professional collaborative practice. Students are facilitated in this process through questions related to each member’s role and scope of practice. The goals for students participating in these types of activities are to expand the students’ knowledge of oth-er health professions and to promote inter-professional understanding of other health professionals’ roles and responsibilities to patient care. It is hopeful that stu¬dents will reflect upon the identification of healthcare professional roles and responsibilities and use such opportunities to collaborate in ways to improve patient. Scenarios change yearly however the outcomes remain the same.
This type of student engagement served as a catalyst for change by integrating learning for our students across disciplines. This is consistent with the mission of our university in that the university is committed to provide quality education to our students and to shape its education programs and policies to express the founding Sister’ values, and attitudes of mercy, service, justice, and hospitality. It is consistent with the AACN mission in that it serves the public interest by setting standards, provides resources, and develops leadership capacity of member schools to advance nursing education, research, and practice.
This program is in place since 2009 and has been successful and all of the participants are enthusiastic about the continuation of it. Response rates on surveys for 2010 and 2011 find that 86.6% - 92.6% respectively found the summit an effective way to understand the role of other health care professionals in the care of patients. The following desired outcomes of this program continue to be met each year:
1) Expand students’ knowledge of other professions and promote interprofessional understanding of other health professionals’ roles and responsibilities in patient care.
2) Identify and discuss gaps and mismatches in understanding of one’s health discipline and other disciplines in the context of patient care.
3) Promote personal reflection about the identification of healthcare professional roles and responsibilities.
This model can be easily replicated in small colleges who do not have a lot of interdisciplinary programs. The greatest amount of energy is the coordination piece which is handled by one key person from each program taking the lead and representing the program at organizational meetings. Other AACN programs who participate in this summit are Wilkes University, Marywood University, and the University of Scranton.
The following are the ways that the IPE summit meets the award criteria:
- The IPE Summit served as a catalyst allowing a small school to be able to participate in an interdisciplinary experience without having all of the resources on the campus. It provided a mechanism for a yearly IPE experience.
- The first Summit was in the spring of 2009 and continues to attract students to three campuses yearly.
- A manuscript was published in Pennsylvania Nurse to disseminate this information in an effort to stimulate replication of similar programs. (Mailloux, C. (2011). Interprofessional education: Positive effects on patient outcomes. Pennsylvania Nurse 66 (2), 12-13).
- A future endeavor to look at another collaborative experience in Viet Nam is being investigated with the Commonwealth Medical College and Misericordia University.
- This IPE experience reinforces Misericordia University’s dedication to the mission and vision of AACN to continuous improvements in quality, efficiency, and accountability through an evidence-based curriculum which prepares undergraduate nursing students for entry into professional nursing practice and fosters a commitment to life-long learning. This program is consistent with the core competencies identified by the expert panel for Interprofessional Collaborative Practice (2011).
The nursing program continues to engage in Interprofessional collaboration within the university also. At the present time we have an Interprofessional pilot project within the College of Health Sciences, involving collaboration between nursing faculty and faculty from the Speech and Language Department. The project entails baccalaureate junior nursing students and baccalaureate junior speech and language students working together on pharmacology patient case studies. The goal of our project is to help our students work collaboratively, problem solve, and to enhance a sense of professional role while finding the optimal outcome for the patient.
Lourdes University College of Nursing
Winner-Private School Without an AHC
Lourdes University is a Private School without an AHC. It could also be considered a small school with a University student enrollment of 2386. The College of Nursing BSN program enrolls 272 students in the nursing Major. The faculty in the College of Nursing ambitiously took on the task of revising the entire BSN curriculum between 2009 -2011 to meet the changing demands of the healthcare arena for quality and safety, complexity of care in the acute care as well as the community setting and outcome based and population focused care. This initiative took place at the time that the Carnegie Foundation released the landmark study of nursing education in the United States by Benner, P., Sutphen, M., Leanard, V., and Day, L. (2009) “Educating Nurses: A Call for Radical Transformation”.
After 18 months of weekly meetings, the faculty designed a curriculum which was framed by the Quality and Safety Education for Nursing Education (QSEN) curriculum funded by Robert Wood Johnson and endorsed by AACN, incorporated the values of population focused care and evidence based practice as fundamental concepts, was driven by concept verses content and built around integrated clinical experiences. This cutting edge curriculum was initiated in August 2011 and will complete the first year of implementation May 9, 2012.
The nursing faculty decided to create this new curriculum based on concerns that the patchwork changes of the curriculum over the years were fragmenting the conceptual framework, the American Association of Colleges of Nursing new set of Essentials for Baccalaureate Education in 2008 necessitating modifications to our current curriculum and the Institute of Medicine’s “To Err is Human” report about safety concerns in health care delivery. All of these factors called for a transformation in nursing education that builds on essential concepts of quality and safety; that stresses development of clinical judgment, and fosters a professional identity that emphasizes accountability and responsibility. As a result, the BSN curriculum was transformed.
The goal of the Lourdes University College of Nursing curriculum is to graduate students who possess the knowledge skills and attitudes (KSAs) to impact both individual and system approaches to patient safety and thus transition readily into complex health care systems (QSEN competencies). The additional conceptual themes of culture, value centered care; community and leadership provide students with the context needed to effectively work with diverse populations. The first semester of the nursing major emphasizes, along with core physiological and psychosocial nursing concepts essential for safety, the KSAs related to patient centered care, communication and evidenced based practice. The students will apply these concepts in a community based clinical setting emphasizing skills of professional communication, especially active listening and understanding patient care needs within the context of environment and culture. Psychomotor skills are introduced but not emphasized.
Subsequent semesters expose students to increasingly complex patient care needs and take the students into more complex health care settings. With a strong foundation in the KSAs of safety, communication and evidence based practice; students move on to develop competencies in interdisciplinary collaboration, informatics, and quality improvement within comprehensive health care systems. Clinical placements integrate concepts across courses and move from the community into tertiary care centers. All clinical placements are designed to increase the students’ time in one setting and system in order to observe and evaluate outcomes of care. In the final semester students are placed with nurses employed in the practice setting to complete a professional practicum. The students also engage in a capstone course in which the six QSEN based concepts are fully integrated with the remaining conceptual themes.
The plan of study includes a total of 125 credit hours within a 15 week semester model. Students complete general education courses, prerequisite courses and 60 hours of coursework within the nursing major. A student is able to finish the coursework in 4 years.
This new BSN curriculum has provided our students and the College of Nursing extraordinary opportunities. We presented the new curriculum to ProMedica Health Systems, a locally owned nonprofit healthcare organization serving northwest Ohio and southeast Michigan, and we were able to collaborate for a grant to support quality and safety education for student nurses as well as practicing nurses in our region. As a result of this collaboration, the College of Nursing was awarded a $984,000 over three years from the U.S. Health resource and Services Administration (HRSA), Division of Nursing, Nursing Education, Practice, Quality, and Retention Grant (NEPQR) grant program.
To disseminate the vision and reality of this innovative curriculum change, the College of Nursing is sponsoring a spring conference on May 14 and 15, 2012 to the nursing education and practice community in Northwest Ohio called “Transforming Academic/Clinical Partnerships: A Focus on Quality and Safety Education for Nurses (QSEN). Keynote speakers, Jane Barnsteiner PhD, RN, FAAN and Mary Dolansky PhD, RN will provide the presentations on safety, teamwork and collaboration as well as patient centered care, evidence based practice, informatics and empowering students in quality improvement. The Lourdes College of Nursing faculty will provide presentations on the implementation of this type of curriculum, lessons learned and content oversaturation in nursing education.
Curriculum implementation is new and data collection for outcomes has just begun. However, a series of focus groups with current students demonstrate a general sense of satisfaction and excitement. Ongoing process evaluation with faculty reveal role development as they learn to work in collaborative semester based teams. Response to student learning has been positive, noting improved ability by students to understand patient needs in context and improved critical thinking earlier in the curriculum.
This has been an exciting endeavor for the nursing faculty and the BSN students. They have moved forward understanding the risks and the determination required to make this type of curriculum change successful and sustaining. This innovative integrated, concept driven, quality and safety based BSN curriculum is a paradigm shift from traditional nursing education curricula. This initiative had required perseverance, dedication, creativity and stamina. It is my pleasure to nominate the Lourdes University College of Nursing faculty for the AACN “Innovations in Professional Nursing Education Award”.
Kent State University
Winner - Public School Without an AHC
Kent State University College of Nursing (KSU CON) was nominated for the Innovations in Professional Nursing Education Award for their re-envisioning of traditional nursing education content through implementation of the Care for the Caregiver Consortium. Beginning with a single faculty member (Tracey Motter), nine faculty members within the College of Nursing, as well as faculty from social work and psychology from nine universities across six states, have collaborated to advance the Care for the Caregiver Consortium. Inspired through an innovative partnership with Donna Karan's Urban Zen Integrative Therapy Foundation, we are building programmatic change that will support student self-care. Not on ly will this change enhance graduates' professional presence at the bedside, but it provides the foundation for a multidisciplinary program of research aimed toward sustained change in the quality of nursing education and practice.
The goal of the KSU CON Care for the Caregiver Consortium is to integrate self-care practices into undergraduate nursing curricula and to demonstrate, through a related, interdisciplinary and multi-institutional program of research, how effectively self-care practices contribute to the socialization of new nurse graduates to strengthen their value for and practice of self-care strategies. To date, Care for the Caregiver content has resulted in revision of our introductory nursing courses, and as a catalyst for change beyond our own curriculum, has opened partnerships that already are demonstrating potential to enhance the quality of nursing education, research, and evidence-based practice nationally. We have already begun to see the effects of strengthened resiliency among students and faculty, as both groups engage in Care for the Caregiver activities on the Kent State campus.
At the College of Nursing, the Care for the Caregiver Consortium emerged initially as an effort to address high levels of stress expressed by accelerated, second-degree, baccalaureate nursing students, whose chaotic lifestyles appeared to challenge their abilities to focus on and deal with the demands of the accelerated, undergraduate nursing curriculum. The lead faculty member for the introductory accelerated course (Tracey Motter) was concerned that without attending to their own needs, students and graduates would be limited in their ability to demonstrate compassion at the bedside.
Serendipitously, in early 2010, a Kent State University alumnus connected Kent State University's Vice President for Advancement with Donna Karan, fashion designer and philanthropist. What was not clear, initially, was that in addition to her passion for fashion design, Ms. Karan shared a passion with nursing faculty for nurses' self-care. As her husband, Stephan Weiss, was dying of lung cancer in June, 2010, he had admonished Donna to "take care of the nurses." Ms. Karan viewed the interests of KSU CON faculty as supportive of her own commitment to implementing self-care for nurses nationally.
Following a series of meetings, a partnership emerged between Karan's Urban Zen Integrative Therapy Foundation and the Kent State University College of Nursing. In August 2010, faculty introduced a group of 30, newly-admitted, accelerated BSN students to Care for the Caregiver Consortium philosophies of patient- and self-care, integrating both specific Urban Zen modalities (yoga, Reiki, aroma therapy, breath awareness, and meditation) and nursing content into the introductory nursing course. As they completed the course, participating students shared feedback with faculty indicating that they valued the content and that it enhanced their personal senses of well-being.
Based on student feedback from the Fall 2010 cohort, Care for the Caregiver content was offered to the incoming group of newly-entering second degree students in Spring, 2011. As this offering was initiated, involved faculty who were early adopters conducted a quasi-experimental pilot study to assess the influence of the content on: 1) students' perceived stress levels, using the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983); and 2) students' abilities to be mindful, present in the moment, and focused, using the Mindful Attention Awareness Scale (Brown & Ryan, 2003). Analyses of data from both instruments showed that compared to a comparison group, students in the Care for the Caregiver (treatment) group (n=18) maintained their stress at constant levels from beginning to end of the introductory nursing course, while the stress levels of the comparison group of traditional students in their introductory nursing course (n=20) increased over the course of the semester. In regard to mindfulness, students involved in Care for the Caregiver programming demonstrated increasing skill, relative to comparison group students whose mindfulness skills did not increase over the semester. Although, probably because of sample size, group differences in average mindfulness scores was not statistically significant, findings trended in the expected direction, and the study was expanded.
During Spring 2012, the sample in this quasi-experimental, students from nursing programs at Cleveland State University and Ursuline College were enrolled in the study, which increased participant numbers to 60 Care for the Caregiver students and 80 comparison students. Preliminary analyses of narrative data indicate that students highly value the content included in the Care for the Caregiver curriculum. Data collection was expanded to include three time points, and we will have completed analyses by early Fall 2012.
Adoption of self-care innovations to enhance the quality of professional nursing education continues. First, nine Kent State University faculty members have committed to including Care for the Caregiver Consortium content in their nursing courses, across all programs. In preparation for the re-envisioning of curricula for those courses, all relevant faculty will be trained in self-care modalities. Second, in March, 2012, Kent State College of Nursing planners dedicated the annual "Driving the Future Conference" to self-care and its modalities. The ail-day continuing education-credit bearing program entitled 'Self-Care and Wellness' included an keynote presentation by Dr. Cynda Ruston (Transforming Moral Distress into Healing) intended to contribute directly to bridging the gap between education and practice; self-care sessions led by yoga experts Rodney Yee and Colleen Saidman Yee from the Urban Zen Institute; a presentation by Donna Karan to initiate newcomers to the significance of nurses' self-care; and afternoon breakout sessions focused on research, educational re-envisioning, and self-care. Approximately 200 educators and students, from across disciplines, attended. Third, university administrators worked with the College of Nursing to offer an evening gala that included donors from insurance, healthcare, business, and publishing to celebrate the successes of Driving the Future and to introduce them to the Care for the Caregiver Consortium (and to the Kent State University School of Fashion Design and Merchandising). Fourth, the following day, March 6, 2012, faculty from nine universities and practice sites across three disciplines (nursing, psychology, and social work) spanning six states met together, with representatives from the Urban Zen Institute, in an all-day summit called Changing the Future to examine strategic directions for integrating self-care into nursing education and nursing research. Led by faculty and administrators from the College of Nursing, the summit resulted in development of a white paper and in delineation of next steps for re-envisioning nursing education to incorporate self care and to foster programmatic change nationally.
This exciting initiative has achieved more than desired outcomes; demonstrates excellent potential for replication and dissemination nationally; has involved teams of faculty across nursing programs and across disciplines. As importantly, it serves to advance not only professional nursing education but also the quality of patient care, as it provides self-sustaining skills to nursing students, to help them understand the importance of self-care to the quality of the work they will do. The work is groundbreaking in linking educational strategies to patient outcomes and is especially trailblazing in its interdisciplinary focus.
Advancing Professional Nursing Education
The Care for the Caregiver consortium is consistent with the mission and vision of AACN, as it serves the public interest by setting standards to promote quality nursing education; secures resources to advance awareness and study of those standards; and strengthens leadership capacity of participating units to advance education, research, and practice-not only for nursing but interprofessionally. The Care for the Caregiver Consortium provides support for AACN's vision in that it contributes to the goal of meeting the demand for innovation and leadership in nursing education, research, and practice. We believe that the Care for the Caregiver Consortium will continue to serve as a catalyst for change in nursing education and research as it is replicated nationally and involves increasingly broad teams of faculty. Outcomes of the Care for the Caregiver Consortium will contribute significantly to the advancement of professional nursing education; that contribution will be evidenced through a program of related research that demonstrates the merits of the Consortium for facilitating student success, enhancing quality of nursing education, and strengthening patient care.