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Innovations in Professional Nursing Education Award Winners

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Case Western Reserve University
Winner - Academic Health Centers

In the two years that the QSEN Institute has been sponsored by the Frances Payne Bolton School of Nursing, it has served as a catalyst for change in multiple nursing programs and across academic disciplines. Both locally and nationally, the QSEN Institute has provided the resources required to inspire nurse faculty to integrate contemporary quality and safety principles into curriculum and clinical learning to advance professional nursing education. Dissemination of resources has been accomplished through an updated web site and two national forums with over 700 nurses from across the world.

The members of the QSEN Institute at FPB have served as a catalyst for change within the nursing curriculum at both the undergraduate and graduate levels and have impacted the curriculum in the school of medicine and department of public health. The nursing undergraduate curriculum was enhanced to include the QSEN competencies by integrating quality and safety into the majority of the course objectives. Examples include adding quality improvement as a method of inquiry in the undergraduate research course, teaching systems thinking as a way to prevent errors, and teaching teamwork and collaboration through coaching in the leadership course. A shared teamwork language was created so that contemporary team concepts from TEAMStepps would be integrated into all the CWRU health professions programs. This shared language is reinforced during two interprofessional sessions in which over 400 health professions students gather to experience teamwork and collaboration. To date, we have reached over 1600 nursing, medicine, dental, and social work students. Our Masters in Nursing program has been transformed to have Quality and Safety education as its foundation. This year an experiential course on quality improvement was offered and teams of students followed the quality improvement steps to implement real change in their clinical practice sites. Students examined the root causes of why sequential compression devices are not being fully adhered to on six of the University Hospitals of Cleveland clinical units. Change ideas were implemented to increase the use of the devices in order to bring down the incidence of deep vein thrombosis. Next year, a leadership course will be offered that enhances students’ achievement of the QSEN competencies and integrates a quality improvement project.

Faculty use the resources on the QSEN.org website to guide quality and safety into their courses. We have many example of how QSEN influenced our faculty to enhance their courses. One example is Dr. Celeste Alfes, Director of the school’s Learning Resource Center, who integrated QSEN competencies into all the simulation experiences and uses the QSEN competencies to guide student evaluation. Another example was the work of Dr. Margaret Wheatley who  partnered with mental health clinicians to define the QSEN based clinical competencies for mental health nursing. She conducted an 8 hour workshop partnering with these clinical nurses to re-write the competencies for the clinical component of our undergraduate mental health course. The work of these faculty were stimulated by the competitive internal grant monies offered to faculty to implement their creative teaching innovations. In the Doctorate of Nursing Practice (DNP) program, students engage in evidence based practice and learn to use quality improvement methods to implement evidence into their practice. Through the mentoring of QSEN competent faculty, quality and safety are the basis for many DNP practicums. The work of the DNP students can be found on the QSEN website under evaluation. The QSEN Institute is also launching a DNP Corner on the website as a repository for the contributions of DNPs across the country. The QSEN Institute also has stimulated many DNP students to study the science of safety and quality. Examples of DNP projects include the implementation of a quality handoff bundle, identification of factors to predict falls with injury, and the efficacy of a coaching intervention to enhance teamwork and collaboration. Other students who are faculty have tested QSEN teaching strategies to advance our education science.

The work of the QSEN Institute at the FPB School of Nursing served as a catalyst for the Interprofessional Learning Exchange and Development Program (I-LEAD) funded by the Josiah Macy, Jr. Foundation, http://ipec.case.edu/. This grant provided the opportunity to integrate quality and safety competencies into the curriculum at the school of medicine and department of public health. In addition, the QSEN competencies were a catalyst for the integration of a quality committee to oversee the CWRU Student-run Free Clinic. The QSEN Institute also contributed to the establishment of the IHI Open School here on CWRU campus. Nursing students and medical students have been leaders in our IHI Open School Chapter with a mission of students improving the healthcare of the clients they serve. There website can be found at http://www.caseihi.org/. Several of the members of the IHI Open School Chapter have attended the National Telluride Safety camp (medical student in 2012, 2 nursing PhD students in 2013, and 1 nursing PhD student in 2014). There is also an interprofessional quality improvement course now offered as an elective to students for all disciplines. We are launching a Massive Open Online Course that is a replica of this interprofessional quality improvement course in
September 2014. This quality improvement course has been taught as an interprofessional course for the last 20 years. The MOOC provides the opportunity for all front line healthcare professionals to learn how to implement quality improvement.

The QSEN Institute transferred to FPB in July 2012 and has been achieving desired outcomes. QSEN faculty and students have published manuscripts with quality and safety as the focus (4 publications and over 20 presentations. Other outcomes include the curriculum changes described above as well as the dissemination activity described below.

In 2012, the QSEN Institute debuted a new website with replication and dissemination as
primary objectives. The website includes the QSEN Learning Module series which was designed to help both new and experienced faculty integrate the Quality and Safety competencies into
their nursing programs. Each module explores a particular topic or issue, provides resources, and raises questions to engage users in expanding or strengthening the learning experiences they create with students around quality and safety. Module #9 focuses on Managing Curricular Change for QSEN Integration. This is the model that was used at FPB for implementation and
dissemination of the QSEN competencies. This module contains all of the tools needed for full implementation of QSEN into a school of nursing. The QSEN Institute plans to continue with dissemination of the QSEN tools through an annual QSEN Forum. This Forum will take place at various regions of the country to encourage participants from all geographic locations. If the prior numbers of participants remains the same, in five years the QSEN Institute will have disseminated the quality and safety message to over 2000 nurses. This year the forum included
100 practicing nurses who are learning how to integrate QSEN into nurse residency programs, staff orientation, and continuing education. We are planning to also have students join us next year to start up a QSEN Student initiative.

The QSEN Institute has involved teams of faculty across programs and disciplines. The current faculty QSEN team are Mary A. Dolansky, PhD, RN, Associate Professor and QSEN Institute Director, CWRU; Shirley Moore, PhD, RN, FAAN, Professor and Associate Dean for Research, CWRU; Deborah Lindell, DNP, PHCNS-BC, CNE, Assistant Professor and Director of the Graduate Entry Program, CWRU; and Rebecca Patton, MSN, RN, FAAN, Instructor, CWRU. There is a national team of faculty involved in the QSEN Institute as well.

The American Association of Medical Colleges (AAMC) invited Dr. Dolansky to participate on their committee for teaching for quality (Te4q). This interprofessional faculty involvement has resulted in the AAMC suggesting to teams across the country to be interprofessional. Dr. Dolansky continues to be a speaker for the Te4Q programs.  QSEN also collaborates with the VA Quality Scholars program. Shirley Moore serves as the Nurse Director and Mary Dolansky serves as Senior Faculty in the VA.

The QSEN Institute works to further the mission of AACN by disseminating the AACN QSEN Workshop Modules for both the undergraduate and graduate QSEN competencies; setting standards for quality and safety and providing resources through the website and annual conference. Consistent with the mission of the AACN, the QSEN Institute seeks to develop the next generation of nursing leaders who will impact the quality of our health care system.

The QSEN Institute demonstrates advancement of professional nursing education through nursing education research. As noted above, students in various programs are conducting research projects with a focus on quality and safety with guidance from the QSEN Institute.

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St. John's College
Winner - Small Schools

The Use of Academic Partnerships to Achieve Interprofessional Education (IPE) Curriculum Innovation

The purpose of this project is to implement a comprehensive curriculum plan for IPE that improves the preparation of baccalaureate nursing students for collaborative practice and patient-centered care. Through the power of academic partnerships, baccalaureate nursing students now participate in a variety of interprofessional simulation and classroom learning activities involving the disciplines of respiratory care, pharmacy and medicine.  The goal is that all graduates are prepared for collaborative practice and patient-centered care. The change project began as the nursing program was transitioning to a revised curriculum in the fall of 2013 and was sustained over the past academic year with positive outcomes. To date, the project has resulted in the participation of approximately 200 students across four disciplines, five successful IPE events and several poster presentations to disseminate project outcomes and allow for project replication. Plans are underway to strengthen interprofessional relationships over the next academic year through additional interprofessional opportunities and academic partners.

Project Description: It is often difficult for students in small special purpose colleges to interact with students in other disciplines due to scheduling conflicts and differing learning goals. Until recently, faculty members have held only rare interprofessional education (IPE) experiences within nursing programs at this Midwestern college. Lack of IPE limits student’s opportunities to meet national accrediting expectations that are aligned with Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative, 2011). The use of regional academic partnerships is a creative way to achieve IPE goals. This project serves as a catalyst for educational change within the nursing programs at St. John’s College and has achieved desired outcomes over the past year.                     

Current enrollment in this special purpose upper division college is 124 students in the general baccalaureate program, including the accelerated baccalaureate cohort and the online RN (Registered Nurse)-to-BSN (Bachelor of Science in Nursing) cohort. Interprofessional academic partner’s geographic location range from 6 blocks away to 90 miles away and include learner group sizes that range from 9 respiratory care students to 80 doctor of pharmacy students.
Teams of faculty in several courses and across academic partners worked with the project coordinator to design and evaluate five varied and innovative IPE experiences for students and interprofessional academic partner students. 

  • The “Civility” event held in the fall of 2013 indicated all Year 1 & 2 Respiratory Care participants and Year 4 Accelerated BSN student participants rated program objectives with a rating of either 3 or 4 on a scale of 1=Not at all to 4=To a great extent. These program objectives included defining covert and overt signs of incivility experienced in practice and educational settings and identifying strategies clinical and educational nursing leaders can use collaboratively to foster civility among nursing staff, faculty and students. 
  • The “Cardio-Respiratory all day event” held also in fall of 2013 with Year 3 PharmD students, Year 2 Respiratory Care students, & Year 4 BSN students consisted of an in-depth high-fidelity simulation, a jeopardy game, and a professional panel discussion, all to highlight IPE, cardio-respiratory care and to evaluate student performance and responses. There was no significant difference on change scores pre and post event on the Readiness for Interprofessional Learning Scale (RIPLS). Pre and post event mean scores on the Team Roles Perception survey indicated that participants levels of agreement were higher post event on both “understanding my role” and “defining the roles of others.” In addition, when comparing cumulative faculty mean scores and cumulative student scores using a two factor analysis of variance, all p values were significant on all items, both on communication and teamwork categories. Furthermore, students scored themselves significantly higher than did the faculty member. Event evaluation scores were positive, for example, the mean score for the item “debriefing allowed me to reflect on the importance of team communication” was 6.25 on a scale of 1=Strongly Disagree to 7= Strongly Agree.  This experience concluded with a “Post Experience Blog” revealing rich qualitative information with comments such as: “The IPE day will absolutely have an impact on my future work. I now feel more comfortable communicating with the other professions;” and “The simulation made me realize as the nurse you need to be a patient advocate.” 
  • The “Wit” event held spring of 2014 compared student ratings of the event among Year 2 medical students and Year 4 accelerated BSN students in relation to six interprofessional competencies centered on the topic of death and dying. 
  • The “Newborn simulation” event held in the spring of 2014 indicated consistently higher levels of agreement from Year 1 Respiratory Care students when compared with Year 3 BSN students to evaluation items such as “This IPE allowed me to feel more confident to care for an infant with respiratory compromise”, and “Debriefing allowed me to focus on teamwork”. 

Performance measurement is the primary evaluation design.  This design serves as both an evaluation tool and a management system to guide decision making and improve program outcomes. Measurements include formative and summative student clinical evaluations, student surveys including the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, 1999), graduate surveys, and employer surveys of graduates. The RIPLS consisting of 19 statements designed to measure student’s attitudes toward shared learning was one tool administered to students for descriptive analysis and comparison. Descriptive correlations are measured among the baccalaureate nursing groups and learners from other professions throughout the various IPE events held over the past academic year. All evaluations align with the Core Competencies for Collaborative Practice (IPEC, 2011) and the Essentials of Baccalaureate Education for Professional Nursing Practice. Every interprofessional experience concludes with participating students evaluating their perceived learning. In addition, the team of college and interprofessional faculty evaluate students’ performance while area employers of graduates evaluate practice performance. Both outcome data and stakeholders feedback are cycled into the feedback loop for evaluation and program improvement at the college.              

Discussion: IPE is in its infancy and more research, both qualitative and quantitative, is needed to fully understand best practices in preparing healthcare students for collaborative practice. This successful IPE project innovation served as a catalyst for change within the curriculum and expanded the working relationship of regional academic partners to achieve high quality IPE. These positive experiences led to solid relationships and responsiveness of academic partner interprofessional faculty to join St. John’s College to further their IPE agendas. Clear linkages exist between project inputs, outputs and outcomes. Time spent on the project by the project coordinator, interprofessional faculty, and simulation coordinator have led to planning and development activities resulting in increased faculty involvement, informed stakeholders and innovative IPE development ranging from blogging and classroom learning to panel discussions and team problem solving during simulations. The project has resulted in five successful IPE events, 3 recent regional posters disseminating partial project outcomes and one poster accepted for a national summit. Also of importance, the project has served to enhance interprofessional relationships among institutions and their faculty by meeting a mutually desired level of interprofessional involvement. In addition, several interprofessional faculty scholarship products, as a result of these IPE events, demonstrate scholarship of teaching, which is a particular scholarship focus at St. John’s College. Only examples are provided as full project results are beyond the scope of this letter; however, there are significant findings to date. Outcomes achieved and currently being measured within the change project for the recently graduated students are as follows: (1) Baccalaureate graduates are prepared for collaborative practice and patient-centered care aligned with Core Competencies for Collaborative Practice (IPEC, 2011) beginning in May 2014. (2) Baccalaureate graduates meet national accrediting expectations regarding IPE as perceived by faculty, beginning in May 2014. (3) Interprofessional education partners perceive benefits from interprofessional learning beginning in the academic year 2013-2014. This project results in an integration of IPE throughout the nursing curriculum via didactic interaction, simulation experiences, that assist these graduates to be leaders in the delivery of quality healthcare. In addition, this innovation in professional nursing education increases the involvement and visibility of nursing as a key interprofessional partner while generating new knowledge about the preparation of future nurses.

References

Interprofessional Education Collaborative Expert panel. (2011). Core Competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.:  Interprofessional Education Collaborative.

Parsell, G. & Bligh, J. (1999). The development of a questionnaire to asses the readiness of health care students to interprofessional learning (RIPLS). Medical Education 33, 95-100

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  Fairfield University
Winner-Private School Without an AHC

In order to respond to the needs of healthcare changes  across environments of care, Fairfield University School of Nursing re-examined our Master’s curriculum in order to ensure that we were meeting both the needs of nurses interested in obtaining advanced degrees and the needs of the healthcare system. The MSN in Nursing Leadership (LEAD) was designed.  The overall goals were to increase program flexibility to meet student and workplace needs. Faculty approached the redesign of the generic master’s program with the strong desire to integrate the feedback of key stakeholders. The process began with focus groups of leaders from healthcare organizations in the area. A key discussion centered on the question: “What qualities do you want in your future nursing leaders?” Alumni of the existing generic MSN program also participated in structured focus groups to evaluate program content, experiences and opportunities. Other opportunities were to maximize interprofessional education, integrate revised national standards and develop a multi-faceted plan to evaluate the new program outcomes. The new curriculum increases faculty and student collaborations and allows up to 9 credit hours in non-nursing graduate programs. As students in the new program would now have more academic interprofessional learning experiences, the application/clinical portion was also upgraded. In order to develop experiences that would meet IPE competencies, faculty, together with practice partners, designed and developed clinical immersion experiences that will integrate opportunities for interprofessional collaboration for graduate nursing students.  Enrollment began in the spring of 2013. The program has met with a very positive response by students, offering a multitude of choices within the curriculum for concentrations in areas of student interest and opportunities for interprofessional education.

Award Criteria:
The LEAD program’s goals of richer student experiences and a more collaborative interdisciplinary teaching culture is a model for the campus and very much in keeping with Jesuit Pedagogy.  The curriculum allows for creative and scholarly collaborations focused on improving healthcare while allowing nurses to be more self-directed in curricular choices.

The initial outcomes for the first year of the program include exceeding enrollment goals and expanded curriculum options that have met the diverse needs of students through course selections in any of the graduate schools on campus, as well as some off-campus pursuits. An early example of interprofessional experiences in the program is a Spiritually and Wellness course offered through the Graduate School of Education and Allied Professionals. In this course, traditionally offered to graduate students in Counseling and Education, nurses are not only in class with members of other professions but are paired with these non-nursing graduate students for projects and field experiences.  In another example, the flexibility of the program allowed a student to pursue an opportunity called The Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Training Program. The LEND Program, offered at another academic institution, is a two-semester leadership training program for those who want to develop skills in advocacy/policy, clinical, research, and teaching that are required for a leadership role in a career focused on children with disabilities and other special health care needs and their families.  The student pursuing this opportunity will be able to use the credits earned toward her degree at Fairfield and disseminate the valuable experience in some way through her final practicum on campus.

Although final program outcomes are not yet available, the new program has appeared to be very responsive to student needs, interests and career goals.  The students report satisfaction with the flexibility in course selection and enjoyment with course work with faculty and students from the graduate programs across the campus. Enrollment for fall of 2014 included cohorts from two area hospitals looking to strengthen the leadership infrastructure of their nursing workforce in a variety in a variety of roles.

The faculty team designed the new curriculum with replication in mind. As part of the Jesuit academic network, a meeting of Jesuit nursing program leaders is planned for February, 2015, to discuss the innovative curriculum and share project outcomes.  The revised curriculum model
has been presented at an AACN national conference and a manuscript has been accepted for publication by The Journal of Professional Nursing.

One of the highlights of the program is the development of relationships among graduate faculty of varied disciplines. The nursing faculty team initiated the project as an interprofessional process, partnering with practice leaders and faculty in the other graduate schools on campus. The partnerships will continue to evolve as students move through course work and into practicum experiences working with interprofessional teams to improve patient outcomes. The new curriculum addresses the need to increase interprofessional learning opportunities and develop competencies for students in a university that offers no healthcare profession programs other than nursing. This is a common problem for nursing schools that exist in universities that are not affiliated with academic medical centers.  In order to overcome this challenge, School of Nursing faculty met with colleagues from other schools across campus to identify graduate courses that might help students to develop these competencies.  In some cases, faculty from across the University joined our nursing faculty to teach or co-teach courses within the nursing curriculum.  In addition, elective courses were worked into the new master’s curriculum to offer students the opportunity to pursue areas of professional interest.  A list of elective course offerings was developed so that students could consider courses from different disciplines or concentrate in areas such as business, marketing, informatics, biotechnology, communication, education or special populations.  This collaborative academic model allows for a richer, more self-directed graduate experience with a great variety of courses offered in the School of Business, Graduate Education and Counseling, Arts and Science and the School of Engineering.

The LEAD initiative fully supports the AACN’s mission of advancing nursing education through an academic program that is responsive to needs of multiple stakeholders, collaborative and respects the diversity of nurses in healthcare. Faculty were dedicated to the standards for
master’s education set forth by the AACN, and sought to maximize creative opportunities which would collectively improve population health and the delivery of care.

Conclusion: Academic programs for nursing leadership must be flexible in order to accommodate the changing skill set and competencies needed for the healthcare system of today and the future. Academic and healthcare organizations must maximize resources through collaboration and innovative approaches to delivering a high quality product.  Faculty of Fairfield University
School of Nursing feel strongly that advancing nursing education means working collaboratively, allowing students more control over curriculum options, breaking down academic silos, and allowing interest and creativity to emerge through scholarship in a rigorous curriculum. The LEAD program demonstrates a curriculum model with countless options for success.

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