Past Award Winners Innovations in Professional Nursing Education Awards

2011 Winners

• Academic Health Centers: University of Wisconsin-Madison

• Small Schools: Wilkes University

• Private Schools Without an AHC: (TIE)

  • Texas Christian University
  • University of Detroit Mercy
• Public School Without an AHC: University of Texas at Austin

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University of Wisconsin-Madison
Winner - Academic Health Center

The AACN Innovation in Professional Nursing Education Award on behalf of the University of Wisconsin-Madison School of Nursing under the Academic Health Center (AHC) category.

The Early Entry Option-PhD Program: In an effort to address the need to attract younger, more diverse students into careers in nursing research, UW Madison nursing faculty have developed a pre-baccalaureate entrance into the existing PhD program, known as the “early entry option” (EEO). This option allows academically qualified students who have been admitted to the BS major to be screened and admitted to the nursing graduate program in order to provide seamless progression and preparation for a career in research.

By way of context, the University of Wisconsin-Madison is one of top research universities in the world, with more than $1B in research expenditures in 2009. It enrolls approximately 5000 freshmen each year. The middle 50% of the entering freshman class each year is characterized by GPAs of 3.5 - 3.9, ACT scores of 27-29, SAT scores of 1860-2090, and class ranks in the top 10-15%. The School of Nursing benefits from the academic rigor at Wisconsin, as students apply to the BS nursing major at the end of their second year (or four semesters) of undergraduate study. Admission to the nursing major is likewise highly competitive. In Fall 2010, the School of Nursing screened 371 qualified applications for 154 available slots in the BS Nursing program. The resulting admit class included 58 students with an earned baccalaureate degrees and 10 students with advanced degrees, and the average GPA for the class was 3.5.

Nursing faculty sought to develop a pathway whereby talented students who were already admitted to the BS nursing major and who signaled an interest in nursing science could simultaneously be evaluated for admission into the PhD program. The goals were: 1) to accelerate progression of selected nursing students from the BS through to the PhD, 2) to capitalize on the School of Nursing’s exceptionally strong undergraduate applicant pool and on the rigorous research training model already in place in the PhD program.

The EEO option was launched in 2003. After admission to the BS nursing major, students may then apply to the EEO. Requirements are similar to the graduate school application process on campus (i.e., written application including a statement of career goals and potential research interest, review of test scores and transcripts, references, and interviews with program faculty). Once admitted, EEO students are assigned a three-member advisory committee (undergraduate advisor, faculty advisor, and an assistant dean) who help the student plan their program. EEO students earn a BS (a minimum of 124 credits), an MS or MS/MPH (a minimum of 16 credits) and a PhD (a minimum of 54 credits). Theoretical and clinical course work is consistent with the AACN Essentials for baccalaureate and masters education. The school commits substantial scholarship funding to EEO students during the undergraduate portion of the program, and EEO students receive top priority for available graduate student funding.

The program consists of three integrated components: theoretical courses, early and intensive research training, and clinical practice. Theoretical and clinical course work is consistent with the AACN Essentials for baccalaureate and masters education. Some graduate courses may be substituted for undergraduate courses, if the student is progressing well. Research training is begun early and is integrated through the program. As undergraduates, EEO students participate in the undergraduate honors program and complete an honors thesis. This provides the framework for identifying a faculty mentor and a research focus. During this experience, EEO students are matched with a faculty advisor (major professor). The “goodness of fit” between student and faculty mentor is deemed critical for success. If this match is successful, the faculty mentor typically assumes responsibility for research training throughout the remainder of the program. The EEO student joins the faculty’s research group in weekly meetings, can interact with more advanced doctoral students and witnesses first-hand the challenges of planning and implementing a program of research. As students progress into graduate course work, they begin to refine possible research questions and approaches. They also participate in a weekly research colloquia series that exposes them to the breadth and depth of research in the school. Clinical practice is likewise integrated throughout the first three years, as students complete 12 credits of undergraduate clinical nursing courses and 3 credits of advanced practice clinical coursework. Clinical experiences are individualized wherever possible to support the student’s developing research focus.

Progression guidelines have been developed for each year of the EEO-PhD program; benchmarks and evaluative criteria include performance in required courses, selection of faculty mentor, progress in research (i.e., poster presentations, submission of manuscripts), progress in securing funding (i.e., applications for research funding or fellowship applications). Evaluation of student progress is the responsibility of the advisory committee. Since the program was launched in 2003, 21 students have enrolled, and attrition to date is 48%. We learned some important lessons about student selection in the first four years (2003-2006), as 7 of the first 10 students completed the baccalaureate, but did not continue into the PhD portion. In the subsequent four admit classes (2007-2010), only 3 of 11 have left after completing the baccalaureate degree.

At present, 11 students are in the EEO: five undergraduates (3 first year, 2 second year), and 6 doctoral (1 first year, 2 second year, 1 third year, 1 fourth year, 1 fifth year). Of these 11 students, 8 were ages 19-22 at admission, and 3 were ages 24-27. While this student group is predominantly female (10 female, 1 male), 4 are from underrepresented populations (i.e., Hispanic/Latina, African American, Hmong). Their average admission GPA was 3.6 (range 3.49-3.96) and average composite ACT was 26 (range 20-32).

The first graduate of the EEO defended her dissertation in December 2010, having earned her BS in 2004 and her MS in 2007. She had received an NIH Individual Predoctoral Traineeship, and was a Hartford Building Academic Geriatric Nursing Capacity Scholar. She had 6 publications and 8 research presentations to her credit, and was 28 years old at time of graduation. The next two graduates are progressing beautifully; they are expected to complete in 2014, and both will be under the age of 30.

This model clearly attracts much younger and more diverse students into our PhD program, and it is clear that they can be successfully transitioned from admission to the nursing major through to the PhD. We know from talking with our undergraduate students that the presence of EEO students in their midst has elevated the profile of nursing research and careers in education. The development and implementation of the EEO-PhD has stimulated important faculty discussions about the core of the nursing discipline, how that core is reflected in our BS, DNP and PhD programs and how those programs must connect. It has required faculty in our baccalaureate and PhD programs to collaborate in new ways, and has required our experienced investigators to reach out to a wider array of faculty colleagues across campus in order to support, and literally to keep up with the research interests of this “new breed” of nursing doctoral student.

I believe our innovative EEO-PhD model can be borrowed, replicated and improved upon in any university nursing environment where there are academically strong undergraduates, where faculty can ensure early and continuous engagement of students in research training, and where faculty are prepared to engage the „future of nursing? at very close range by working with doctoral students who are very different from those in our past, but who have enormous potential. My faculty colleagues believe so much in the promise of this model to build the nursing professoriate of the future that we are actively shifting our PhD recruitment to focus to a much greater extent on entering BS students, and to include entering freshmen (major as yet undeclared) at Wisconsin.

I myself have been engaged in doctoral education in nursing for more than 30 years, and am convinced that programs like this one will literally chart new directions for our discipline for decades to come. I hope that your committee shares our excitement, as I know that my faculty colleagues would be most honored to receive this important award. I will look forward to hearing the results of your deliberations, and thank you for your service to AACN.

Wilkes University
Winner, Small Schools

The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at Wilkes University under the Small School category.

Program Description:
In 2009, the Lasater Clinical Judgment Rubric (LCJR) was adopted by the Clinical Nursing Simulation Center (CNSC) at Wilkes University School of Nursing (WU-SON) as the evaluation tool which would be used to measure the development of clinical nursing judgment in undergraduate baccalaureate nursing students.  In an effort to assure quality, efficiency, and accountability in the implementation and evaluation of this tool in the simulation program, a statistical database was created.
 The database is structured to include cases for all students enrolled in the baccalaureate nursing curriculum at Wilkes University beginning with the Fall 2009 semester.  The purpose of the database was to provide a means for the CNSC to:

This database was initiated in the 2009-2010 academic year to store student data collected during simulation activities and to enable the CNSC to use this data to perform statistical analysis of clinical judgment (LCJR) scores for specific student cohorts. The results of the statistical analysis provided quantitative data which supported the objectives and goals of the simulation program, which was initially integrated into the nursing curriculum at the beginning of the 2008 academic year. The database is currently being expanded so that further statistical analyses can be done to determine relationships and correlations on multiple variables as a means of assuring quality, efficiency, and accountability in the implementation and evaluation in other aspects of the undergraduate nursing curriculum. Data obtained through this database also have been useful in advancing faculty interactions with the CNSC, and vice versa, which have in turn, led to changes in the curriculum and instruction in courses, the clinical setting, and the CNSC.

Mission:
The mission of the Wilkes University School of Nursing is to prepare professional practitioners of nursing who have mastered the core concepts and principles of the discipline, to address ethical issues in practice, to promote lifelong learning and to serve others with intelligence, compassion, and integrity in a constantly evolving, multicultural environment. Consistent with this mission and the vision of the WU-SON, simulation integrated into the undergraduate nursing curriculum is designed to prepare professional nurses for an evidenced-based practice in an increasingly complex healthcare environment.
The role of the simulation program in this curriculum is to create a learning environment in which undergraduate nursing students are exposed to complex clinical situations in a standardized and controlled simulation setting. The goals of the simulation program are to provide a system by which students can develop clinical nursing judgment and to employ a standardized and centralized mechanism by which the development of clinical judgment is objectively evaluated in order to provide feedback to enable curricular changes for continuous quality improvement.

Program and Program Outcomes:
In 2006, Wilkes University began to explore the use of simulation in undergraduate nursing education and, in 2007, the CNSC was established with the intent of integrating simulation into the undergraduate nursing curriculum using the philosophical underpinnings of Benner’s Theory From Novice to Expert. The goal of the simulation agenda is to provide a mechanism by which students are exposed to complex clinical situations followed by a formative debriefing session as a means to assist in the development of clinical nursing judgment. In 2008, an educational session was held on simulation and faculty began integrating clinical simulations into each clinical nursing course. At the end of the 2008 academic year, systematic review of the curriculum and evaluation of the simulation agenda revealed a need for an objective method by which this clinical nursing judgment can be evaluated.
In response to this identified need, the Lasater Clinical Judgment Rubric (LCJR) was adopted as the evaluation tool.  The LCJR was chosen because it is consistent with the philosophy of Benner and it was specifically designed to measure a student’s clinical judgment during performance in clinical simulations in cognitive, psychomotor, and affective domains of learning. The LCJR scoring gives a quantitative measure of a student’s clinical judgment and establishes a level of development for each student as either beginning, developing, accomplished, or exemplary. The LCJR and scoring parameters were distributed to all faculty during an educational session held at the beginning of the 2009 academic year.

In an effort to assure quality, efficiency, and accountability in the implementation and evaluation of the simulation agenda integrated into the nursing curriculum, a SPSS database was also created in 2009 so that data on student clinical judgment can be centralized and used for analysis of both student and program outcomes. Also, because the LCJR was new, the SPSS database included variables to monitor inter-rater reliability.

While the simulation program and database were designed specifically for pre-licensure students, the importance of such a program in the evaluation of students was recognized. The graduate curriculum for Nursing 542: Evaluation in Nursing Education was updated to include the LCJR, its scoring parameters, and the importance of inter-rater reliability. The graduate students enrolled in that course participated in student evaluations using the LCJR in clinical simulations in the CNSC beginning in 2009.

Data collected using the LCJR to evaluate students’ clinical nursing judgment in simulations were entered into the database and analyzed based on student cohorts of sophomore, junior, and senior. Data analysis showed that both mean and median LCJR scores were higher for the junior level cohort as compared to the sophomore level cohort and LCJR scores were higher for the senior level cohort as compared to the junior level cohort. It was also noted that the range of scores for the sophomore level cohort was larger than the range of scores for both the junior level cohort and the senior level cohort. And the range of scores for the junior level cohort was larger than the range for the senior level cohort. An independent-sample t- test comparing the mean scores of the sophomore students (NSG210) and the mean scores of senior students (NSG310) found a significant difference between the means of the two groups (t(88) = -2.684, p <.05). The mean of the sophomores is significantly less (m = 25.98, sd = 6.86) than the mean of the seniors (m = 29.48, sd = 5.27).The results suggest that overall clinical judgment skills improve as students transition through the baccalaureate nursing program and clinical judgment skills become more consistent among students as they approach program completion.

As the simulation program is dedicated to the mission of the WU-SON, the use of the database to demonstrate the development of clinical nursing judgment in the enrolled students supports the School’s mission to prepare professional practitioners of nursing who have mastered the core concepts and principles of the discipline. Curricular changes that resulted from the new simulation program are:

The curricular changes that came about from the introduction of the new simulation agenda were well-received by faculty and administration. The program development and results were presented by the CNSC Director at the International Nursing Association for Clinical Simulation and Learning (INACSL) Conference in Las Vegas in June 2010 in an effort to stimulate curricular changes in nursing education that will foster large-scale changes for the integration and evaluation of development of clinical nursing judgment in pre-licensure nursing students.

Data continue to be entered into the database and descriptive statistical data is reported as part of the CNSC’s monthly report. In 2010, WU-SON faculty requested use of the database as a central and standardized method for storing not only information on simulation but also other variables that can help in evaluating the undergraduate nursing curriculum. During the 2010-2011 academic year, the CNSC Director met with the Assistant Dean of Academic Affairs and Assessment and the WU-SON Associate Dean to begin expanding the statistical database to allow for routine analysis of quantitative statistical data on students and student cohorts in cognitive, psychomotor, and affective domains and provide access to this historical data for longitudinal studies. In the Fall of 2011, educational sessions will be held for all WU-SON faculty so that use of the statistical database becomes an integral part of systematic evaluation.

Meeting the award criteria:

• This program served as a catalyst for change by integrating a simulation agenda into the undergraduate nursing curriculum using the philosophical underpinnings of Benner’s Novice to Expert Theorem

• This program was implemented in 2009-2010 academic year, was sustained in the 2010-2011 academic year, and is now a part of the ongoing systematic evaluation of the School of Nursing.

• Information on this program was disseminated via conference podium presentation in an effort to stimulate replication of similar curricular changes in other nursing programs.

• This program was a collaborative effort by the administration, faculty, and staff of the Nesbitt College of Pharmacy and Nursing.

• This database reinforces Wilkes University’s dedication to the mission and vision of AACN to continuous improvements in quality, efficiency, and accountability through an evidence-based curriculum which prepares undergraduate nursing students for entry into professional nursing practice and fosters a commitment to life-long learning.

Texas Christian University -
Winner, Private School Without an AHC

The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at Texas Christian University (TCU) – Harris College of Nursing and Health Sciences (HCNHS) under the Private School without an Academic Health Center category.
Summary: The purpose of the Baccalaureate Nursing Emphasis in Oncology (BNEO) at Texas Christian University (TCU) - Harris College of Nursing & Health Sciences (HCNHS) is to increase nursing students’ desire and decision to practice in an oncology setting upon graduation. Established in Spring 2008, the programmatic innovation offers baccalaureate nursing (BSN) students the opportunity to complete an emphasis in oncology within their generalist nursing preparation. The program has demonstrated success in recruiting students to oncology nursing after graduation as well as serving as a curricular model for other areas of nursing for BSN students. TCU’s academic partnership with the University of Texas Southwestern Medical Center (UTSW) provides the opportunity for our students to experience oncology clinical opportunities in a National Cancer Institute designated center.

Description of the Programmatic Innovation
There is a dramatic need for oncology-specialized nurses to care for the growing population of people diagnosed and living with cancer, as well as for caregivers of cancer survivors. The Baccalaureate Nursing Emphasis in Oncology (BNEO) is an innovative strategy to promote interest and skill development in oncology nursing among BSN students. The BNEO program used the Oncology Nursing Society (ONS) Standards of Oncology Nursing Education: Generalist Level Education as the framework for the development of the oncology curriculum and collaborative clinical experiences (Jacobs, 2003). Graduates of the program have been well-prepared and motivated to enter oncology nursing practice.

Courses developed or supplemented for the oncology emphasis program are guided by the criteria statement from ONS: “To ensure that the science of and technical skills associated with the physical, psychosocial, spiritual, and cultural care of the patient with cancer necessary when examining prevention, early detection, risk reduction, treatment, rehabilitation, palliation, and/or end-of-life principles are included (Jones, 2003).” Although oncology nursing is an established specialty, many nursing programs lack focused oncology clinical and didactic experiences for students resulting in a failure of students to explore careers in oncology after graduation. The foundation for the BNEO is two upper-division undergraduate courses.

Aspects of Oncology Care is a three-credit course that requires didactic and outpatient rotations coordinated with the Simmons Comprehensive Cancer Center at the University of Texas-Southwestern Medical Center (UTSW). Didactic content is provided in an intradisciplinary approach by oncology clinical experts at HCNHS, UTSW and other oncological resources in the community. Clinical experiences for each student are required and coordinated through the outpatient clinics at UTSW. These include four 8-hour days in these clinics: Bone Marrow, Infusion, Gynecology-Oncology, Surgery, Radiation, & Hematology/Oncology, as well as the Interdisciplinary Care Clinic. Students also join the Oncology Nursing Society and attend local chapter meetings; becoming engaged in the professional aspects of oncology nursing.

The second course, Oncology Residency, is a three-credit hour, precepted internship with an oncology certified registered nurse. Students are placed on the adult general oncology unit, bone-marrow unit or pediatric oncology unit at one of three hospitals associated with UTSW medical system. Students complete nine 12-hour shifts and must demonstrate that they can competently and independently care for up to four oncology patients.

An additional aspect of the program is an Oncology Internship Program coordinated collaboratively with a large local oncology physician group with opportunities for urban and rural settings. BSN students must apply for the Oncology Internship and have successfully completed Aspects of Oncology Care. Interested students submit an essay speaking to their interest in oncology and career goals. A committee of oncology nursing faculty and nurses from the oncology group select participants for the internship. Students selected have experiences in medication administration, intravenous starts and accessing venous access devices, dressing changes, patient monitoring, opportunities to gain an understanding of case management and financial aspects of oncology patient care, and caring for the caregiver and family.

Since inception of the BNEO, 75 students have completed Aspects of Oncology Care (38 have graduated) and 23 students have completed the Oncology Residency (16 have graduated). Twenty-four students have entered oncology nursing upon graduation. Twelve students have participated in the Oncology Internship Program. The practice site for the Oncology Internship has employed one of the participants full-time upon graduation and continues to use three of the program graduates part-time.

As part of the BNEO, professional development opportunities have been offered to all TCU students, members of the entire TCU community (faculty/staff), the community of Fort Worth, and Dallas–Fort Worth professional cancer care providers. These have included continuing education (CE) workshops on radiation oncology; prostate cancer, cervical cancer, breast cancer, cancer prevention for women, and most notably, an annual full-day CE symposium for oncology nurses. These offerings have enhanced the relationships of the TCU–HCNHS reputation for being on the forefront of oncology practice for nursing and served to establish HCNHS as a baccalaureate program for students interested in oncology as a nursing specialty area.

In addition to the standard undergraduate nursing curriculum, assignments and activities in several other standard nursing curriculum required courses have an oncology-emphasis requirement for students participating in the program. With assistance from Community Partners, students participate in expanded didactic and clinical content on long-term effects, caregiver concerns, palliative care, primary, secondary and tertiary prevention, as well as end-of -life care and decision-making. Partners allow students to participate in and experience the valuable role of an interdisciplinary approach to cancer care from diagnosis, survivorship and end-of-life. Graduates of the program have been able to immediately contribute to institutions and communities as knowledgeable health care providers regarding services and needs of cancer survivors along the survivorship continuum.

The BNEO meets award criteria in the following ways:
Catalyst for change within the curriculum and/or educational mission of the institution. The Oncology Emphasis has served as a model for two subsequent initiatives: gerontological nursing course with interprofessional practicum experience and perioperative nursing course. Since initiation of the BNEO there has been a documented increased interest, not only dialogue, among faculty about oncology, but also research and community programming in oncology.

Sustained for at least one year and met outcomes. The program has been sustained since January 2008 and has met outcomes for student participation, faculty collaboration and awareness, and fostering community partnerships. The program has increased enrollment from 10 in year one to 30 this past year; and the number of graduates being employed in an oncology setting has consistently increased with each cohort.

Involved faculty teams. In addition to the standard undergraduate nursing curriculum, assignments and activities within several other required courses within the standard nursing curriculum have an oncology-emphasis requirement for students participating in the program.

Consistent with AACN mission and vision. The innovation is an exemplar of a strategy to meet human and societal needs through nursing. It is a proactive strategy to prepare baccalaureate nurses who are ready to respond to emerging knowledge about cancer and the increasing need to effectively care for survivors and their caregivers in a variety of different settings.

Demonstrates advancement of professional nursing education. The program highlights the role of the baccalaureate nurse in oncology care and demonstrates nursing’s commitment to prepare individuals ready to collaborate with other disciplines and community agencies to meet the needs of persons with cancer, survivors, and their families.

Recent literature documents that a shortage of registered nurses in oncology is a reality that the profession must address, given an aging population, concurrent aging of the oncology workforce, the nature of cancer, and increased number of cancer survivors. Specific to the National Action Plan for Cancer Survivorship, the program supports the prioritized need for the development of specific oncology curriculum, clinical experiences and an externship that students do not currently participate in. However, students have the opportunity to participate in the oncology internship. Curriculum content is aligned with care across the lifespan focusing on the issues of survivorship for cancer patients.

Nursing students frequently see cancer as a fatal condition and believe that oncology nursing lacks the complexity or excitement found in other clinical settings. By providing focused clinical experiences in different oncology settings and oncology-specific curricula, the BNEO has achieved its major aim to increase the number of baccalaureate nursing graduates that select a career in oncology nursing. In addition, the innovative program can be implemented and sustained in other programs of nursing.

References
Centers for Disease Control and Prevention and Lance Armstrong Foundation. 2004. A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. Atlanta: Centers for Disease Control.
Jacobs, L., ed. 2003. Standards of Oncology Nursing Education: Generalist and Advanced Practice Levels. 3rd ed. Pittsburgh: Oncology Nursing Society.

 University of Detroit Mercy -
Winner, Private School Without an AHC

The AACN Innovations in Professional Nursing Education Award on behalf of the School of Nursing at University of Detroit Mercy under the Private School without an Academic Health Center category.

Overview:  Dramatic changes in health care, movement towards a global society, continued budgetary restrictions, learning needs of new millennium students and increasing multidisciplinary efforts to accomplish a variety of goals were a few of the reasons the University of Detroit Mercy (UDM), McAuley School of Nursing (MSON) recently initiated an innovative multidisciplinary nursing course into the curriculum.  The overarching goal of the multidisciplinary effort is to train students how to effectively collaborate with members of other disciplines, advance nursing education and improve practice in order to ameliorate care.  The school of nursing has established collaborative relationships and formed strategic alliances with the school of engineering, local health care providers, and the surrounding community and by doing so has advanced baccalaureate nursing education.  Multidisciplinary collaboration in baccalaureate nursing education has the potential to create fertile grounds for learning beyond that of a single discipline approach.  Specifically nursing and engineering faculty have developed a way to inspire and stimulate their students to learn and use the knowledge they’ve gained to provide care to their clients.  This innovative multidisciplinary educational approach effectively meets the learning needs of our current students while helping members of our community.

Introduction:  In 1988, the US Federal Government passed the Technology-Related Assistance for Individuals with Disabilities Act (“Tech Act” 2000). Increasing the availability of assistive technology as well as the capacity to provide technology-related assistive devices were two objectives of the federal act. Accordingly, in 2008, the departments of Nursing and Mechanical Engineering at UDM collaborated to provide unique assistive devices to physically challenged individuals living in the Detroit Metro Area while teaching multidisciplinary collaboration.  Following classroom instruction the student teams, under the supervision of the nursing and engineering faculty, meet people from the local community with a physical disability.  Individuals requiring assistance are identified through a variety of developed partnerships such as Michigan Rehabilitation Services, Veterans Administration (VA) Hospitals, Michigan Spinal Cord Association and personal contacts.    The students interact with the client to assess his or her needs.  Collaboratively, the students and the client determine a device that could be built in order to improve the life of the disabled person.  Nursing students inform the team about the specific physical disability and its implications, help with design ideas and evaluate the device and the client for any potential health related issues. Engineering students design and build the assistive devices identified by the client and make necessary iterations until a satisfactory device is completed. The multidisciplinary student team works together to provide a safe, useful and health conscious device with the goal of improving quality of life.   Nursing faculty and engineering faculty collaboratively teach bi-weekly in the classroom and also facilitate the multidisciplinary student interactions as they build the devices for the clients. 

Description, Outcomes & Title: The title of the program is “Enhancing Education Using a Multidisciplinary Program Building Assistive Devices for Physically Disabled People”.  The goal of this interdisciplinary educational effort is to teach collaboration and team work between disciplines in order to prepare graduates with skills necessary to work in a global society while positively impacting the lives of others.  The collaboration between mechanical engineering and nursing in this manner lends support to Kijima’s (2007) encouragement to advance multidisciplinary work in the systems sciences where one system is mechanical and the other human.  The outcomes for the course are as follows:  1.) Students will have an improved understanding of the roles engineers [nurses] have in the development of assistive technological devices.  2.)  Students will demonstrate improved collaborative and communication skills with members of other disciplines.  3.)  Students will state enhanced understanding of how to apply learned skills to a variety of problems.  4.)  Students will be exposed to needs of people in the community and design strategies to improve those needs.  5.)  Students will state an anticipated enhanced ability to communicate across disciplines in the workplace post-graduation compared to their colleagues without multidisciplinary training.  Pre and post course surveys of students demonstrated that all outcomes have been effectively met.     

Award Criteria: Since the initiation of the multidisciplinary course both nursing students and engineering students have had the unique opportunity to learn collaborative skills which serves as a catalyst for change to nursing curriculum, with the goal of additional multidisciplinary opportunities incorporated into other nursing and university courses.  MSON is advancing professional nursing education by offering this unique type of multidisciplinary education.  In addition, the faculty teaching the multidisciplinary course have disseminated information on how other universities can replicate this program.  The goals, purposes and techniques of this unique learning experience has been presented at the American Association of Colleges of Nursing Baccalaureate Education Conference (November, 2010), the Michigan Academy of Science Arts and Letters Annual Conference (March 2010), the Nurses Trusted to Care Conference (May 2011 – poster), featured on Pubic Network Television (August 2009, http://www.youtube.com/watch?v=DNmE3TxQ828) and published in a pending issue of Michigan Academician (in press).  It is our hope that other colleges and nursing programs will begin to incorporate similar programs into their curriculum with the goal of graduating nurses proficient in applying their nursing skills in expanded ways.  Nurses need to have input when devices, technology and electronics are being designed for patients.  Currently, far too few products being used in clinical settings have been influenced by the expertise of the nurses who will be using them.  It is our goal that nurses lead the delivery of quality health care and help generate new knowledge to improve health and the delivery of care services. In order to accomplish this objective, consistent with the AACN vision, nurses need to be educated to communicate and collaborate with other disciplines in order to enhance technology used in clinical settings and patient lives.

We have just completed our third year of the multidisciplinary nursing/engineering course.  The program is consistent with and fully supports the mission of UDM which states, “The University of Detroit Mercy, a Catholic university in the Jesuit and Mercy traditions, exists to provide excellent student-centered undergraduate and graduate education in an urban context. A UDM education seeks to integrate the intellectual, spiritual, ethical and social development of our students.”  Our program develops students by educating them to use their intellectual skills learned throughout their courses at UDM in order to improve the lives of people living in our urban community with physical disabilities.  The students also include the spiritual, ethical and social aspects involved in providing for the needs of the physically disabled living in an underserved area.   In addition, our multidisciplinary course provides resources which serve the public, is creatively, uniquely and innovatively advancing nursing education and practice to meet the demands of the 21st century health care, objectives consistent with the mission of AACN. 

Our program was recently awarded a NCIIA grant (#8286-10, “Student designed technologies for the disabled”) which will financially contribute to additional and improved devices that our students can build for the physically disabled persons in our urban community.  The multidisciplinary student efforts have produced innovative devices such as:  a hand grasper for a former police officer with right sided hemiparesis from a gunshot wound to the head, an ankle strengthener / exerciser for a man with multiple sclerosis, a torso & triceps strengthener for a paraplegic man, a side sliding crib for a wheelchair bound mother, a motorized wheelchair mover for non-electric wheelchair users, a liquid food feeding tool for burned patient unable to feed himself liquids due to contractures and loss of fingers, a camera stabilizer for a photographer with Huntington’s Chorea, and laundry tub extractor for a woman with Spina Bifida.

Challenges:  We have encountered some limitations in our collaborative course.  For example, scheduling conflicts and time constraints between nursing and engineering students have made team meetings occasionally difficult to schedule.  Also, initial differences in professional language and jargons make communication between disciplines somewhat problematic.  However, the initial language barriers become an outcome met towards the end of the term as each discipline begins to learn and understand how to collaboratively communicate with the other discipline.  The faculty view this phenomenon as meeting course objectives 1, 2 & 5.  An example of this is noted during the stage when a perceived design is presented to the client but revisions are needed.  The engineering students refer to revisions as “iterations”; the nursing students refer to revisions as “alterations to interventions”.  Interestingly, by the end of the term both groups of students understand the others language without explanation.  Another example is the ease that nursing students understand and can explain words like spina bifida, contractures, and hemiparesis to the engineering students but also leave the course understanding words like gantt chart, prototyping, and sequential dependency. 

Conclusion: Despite some challenges to multidisciplinary education, the nursing and engineering students have stated that the course had a positive impact on their realization of the needs of people in the community and how their unique skill sets can be used collectively to ameliorate those needs.  The students have also verbalized an improved understanding of the need for multidisciplinary efforts in the workplace to design equipment built by engineers, used by nurses to improve health care. Both the engineering students and the nursing students have stated an enhanced understanding of the others’ discipline and have expressed a desire to work with other disciplines as a means to improving care.    In addition, lives of physically disabled people in our local community have been positively impacted because two very different disciplines have learned to work together.
Please do not hesitate to contact us if you have any additional questions regarding our awesome multidisciplinary program.  We are very proud of this work and the impact it will have on the future of baccalaureate nursing education.

The University of Texas at Austin -
Winner, Public School Without an AHC

View innovation summary in PDF

 

2010 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

 

University of Maryland - Winner, Academic Health Center

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.

Nazareth College - Winner, Small School

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.

The Catholic University of America
School of Nursing

Catholic University - Winner, Private School Without an AHC

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

View innovation summary in PDF

 

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2009 Winners

• Academic Health Center: University of Kentucky

• Small School: York College of Pennsylvania

• Private School Without an AHC: Pace University

• Public School Without an AHC: Rhode Island College

University of Kentucky - Winner, Academic Health Center

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.

York College of Pennsylvania - Winner, Small School

In the late 1990’s increased enrollment in the Department of Nursing at York College of Pennsylvania (YCP) created challenges for providing clinical placements.  The Community Health Course Coordinator pursued development of a Nurse Managed Center (NMC), the initial intent being to provide appropriate clinical sites to accommodate larger numbers of students in the community health nursing course. Three goals were established

1. To provide service learning clinical experience where students could meet the community health clinical course objectives

2. To provide wellness services to a medically underserved and economically disadvantaged population

3. To establish a community-campus partnership.

As the NMCs developed these goals were met and many other positive outcomes were also realized.

In early 2000, we entered into a partnership with the York Housing Authority (YHA) to open an NMC in Broad Park Manor (BPM), a complex for low income elderly and disabled individuals. In September 2001, the BPM Wellness Center became operational. Throughout the fall and spring semesters of that academic year, the Wellness Center was open one day per week when the college was in session. Students worked with individuals and aggregates from BPM, providing health assessment and health teaching. The Wellness Center evolved during that first year. The programs and activities were developed by students, with faculty supervision.  Students provided individual health assessment and health teaching and carried out aggregate interventions such as blood pressure screening, exercise class and health fairs. 

The Wellness Center proved to be an excellent site for students to meet the clinical course objectives. BPM residents were satisfied with the services they received based on findings from client satisfaction surveys. In addition, the partnership between the Nursing Department and the YHA grew strong and positive.

The BPM Wellness Center remained open throughout that first summer staffed by an Advanced Practice Nurse and student externs. Funding for the staffing was through a grant obtained by YHA. The second year, BPM Wellness Center was opened two days per week, providing this excellent clinical learning for even more students and offering more services to the BPM residents.

Because of the success of the BPM Wellness Center, YHA provided space for a Wellness Center to serve residents in other low income housing complexes. This center, the Jefferson Wellness Center, opened in the Fall of 2004. As with the Broad Park Manor Wellness Center, this Center proved to be a valuable clinical learning experience for students while providing health promotion and disease prevention services for low income York City residents. With the opening of this center, we were able to have two thirds of the students in the community health nursing course complete at least a portion of their clinical in a NMC.

The following year, a representative from another housing agency, Delphia Management Corporation, contacted the Course Coordinator requesting similar collaboration. Delphia provides low income housing in York city for a variety of population groups. In the Spring of 2006 the Delphia Wellness Center was opened. The opening of this center allowed sufficient clinical sites for each student in the community health nursing course to have a rotation in one of the NMCs.

Fundraising efforts to staff the NMCs when the college is not in session have been challenging but successful. Each NMC is now open two days per week when the college is in session, and one day per week during college breaks. Remaining open year round improves continuity of care for the residents, provides clinical practice opportunities for faculty and gives students who are particularly interested in community health nursing the opportunity for additional clinical experience as paid student nurse externs.

The campus-community partnership is strong with both the YHA and the Delphia Management Corporation. We’ve collaborated with other service providers including the York City Health Bureau to provide influenza immunizations, and numerous agencies to conduct health fairs and screenings.

The NMCs were the focus of a public relations campaign conducted by the College. A radio advertisement highlighting the unique service learning opportunity for students launched additional interest that resulted in a television advertisement. Newspaper articles in the local paper have included photos and coverage of health fairs, immunization clinics and even one feature on a pet therapy intervention. Such positive public relations have benefited both the college and our community partners.

YCP have obtained funding for special programs, such as an Asthma Safe Kids program that provides in home teaching for caregivers of children with asthma. Students who conducted these visits collaborated with faculty in research data collection and in presenting findings.

Interdisciplinary collaboration with other Departments in the college has also occurred. Students in a Graphic Arts Design course developed our NMC logo. Students in a Grant Writing course have written grant proposals. Students in a Social Aspects of Aging course have collaborated with faculty in the Behavioral Science Department conducting an Oral History Project research study.

The clinical experience that our students have received in the NMCs has been remarkable. Our initial goal was that the students would be able to meet the clinical course objectives, but students have expressed learning that goes beyond those objectives. In the NMCs students are able to have continuous client contact, allowing them to establish therapeutic nurse client relationship in ways they have not previously experienced. Based on student feedback regarding the value of this experience, students are now in the NMC for clinical for an entire semester, rather than for a half semester rotation.
   
Despite efforts to increase the diversity of the student population at York College we continue to have a homogenous student population of white, middle class, traditional college students. This clinical experience with low income clients is a cross cultural experience for our students. Through working at the NMCs, students see differences in quality of care from what they are accustomed to. They see the hardships that low income individuals face and articulate how it will change the way they view patients in any setting.

During the first year of operation, 382 client encounters were documented. Last year, we had over 2500 client encounters between our nursing students and low income York city residents.

Pace University - Winner, Private School Without an AHC

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.

How were Award Criteria Met?

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.

Rhode Island College - Winner, Public School Without an AHC

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.

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2008 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





University of New Mexico - Winner, Academic Health Center


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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.






Shenandoah University - 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).




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.

Outcomes of the program included:

• Students across the home-base observe role modeling of faculty in the community and have the opportunity to develop partnership skills.

• Students become invested, share ownership and challenge faculty to assure sustainability of their efforts.

• Students share recognition by being featured in print and television media for their contributions to the community, co-presenting at professional conferences and receiving national awards.

• 47% of exiting students report they would “very likely/somewhat likely” consider a future career in community/public health nursing.

• 90% of exiting students report supporting the SON community curriculum.

• Faculty has secured participatory grants shared with community partners.

• Receipt of advocacy and service awards has distinguished the SON and UNF.

• Faculty enjoy the long-term mentoring relationship with a cohort of students.

• Community agency partners benefit from over 250 service-learning projects performed over a seven-year period, which increased agency capacity.

• Partners participation in continuing education retreats with faculty.

• Faculty participate in many local non-governmental organization boards/committees.

This programmatic innovation meets all the identified criteria for the Innovations in Professional Nursing Education Award. Sustainability is expected and fully supported by the University. The SON has served as a model for service learning within the University and was a catalyst for change as Community-based Learning and Community Involvement was incorporated into the University’s Quality Enhancement Plan. The curriculum was implemented in 2001 and continues to be strengthened through the support of faculty and community partners. The program involves all faculty, either directly or indirectly, and all have had input into the development and fine-tuning of the program. At least 14 faculty members are actively involved in home-base activities, while the remaining faculty members support these activities. Additionally, the program has potential for replication and other Universities have already asked for ideas on how to implement similar programs into their curriculum.