Research/Scholarship, Ethics, Advocacy, Leadership

Bethany Coyne/CDI Day#4 Draft

Course Professors:

Bethany Coyne, PhD, CPNP, RN
Phone: 434-982-1493
Office Number and Location: CMNE 2121
Email: bmc8b@virginia.edu

Connie Lee, EdD, RN
Phone: 434-924-9530
Office Number and Location: CMNE 2123
Email: cwl2e@virginia.edu

Pamela DeGuzman, PhD, MBA, RN
Phone: 434-243-3964
Office Number and Location: McLeod 5011
Email: deguzman@virginia.edu

Classroom:

McLeod 2005 (Coyne)
McLeod 1003 (Lee)McLeod 1004 (DeGuzman)
Monday/Wednesday 10:50 am-ll:50 am

Class Schedule: Monday/Wednesday 10:50 am‐11:50 am

Course Description:

Welcome to REAL (Research/Scholarship, Ethics, Advocacy, Leadership) II! The REAL courses are designed to supplement the core nursing courses such that you will not only be prepared for the technical side of nursing but also the broader picture including the mind, body, spirt and emotional sides of nursing. Nurses as the bedside use research, ethical principles, advocacy, and leadership leaderships to drive their care of patients daily. Within the progression of four REAL courses, REAL II will be weighted toward the research and leadership components but will also have some ethical and advocacy content.

Each of you have chosen nursing for a reason. You hope to heal, comfort, and support your patients and their families during wellness and in the face of illness. Many of you see nursing as a calling. Throughout this semester you will be entrenched in clinicais, pathophysiology and med/surg. But, do you ever wonder how nurses can use their skills, knowledge, and empathy to provide optimal care? How does research factor in to providing quality care? How is quality care measured? What happens when there are poor outcomes? Nurses are "doers", when they see problems they want to fix them. They need to be able to assess, respond and evaluate both at the patient level and within larger systems of health care. Whereas the research component in REAL I was primarily looking at historical methods, during REAL II, you will learn about quality improvement and nursing sensitive quality indicators, what they are, how they are measured, and how to go about making change to improve outcomes.

What happens when nurses face ethically challenging situations? In REAL II we will have the opportunity to upon the foundational knowledge of nursing ethics from REAL I to further explore ethically charged situations often faced by nurses and explore resources for managing these challenges.

Nurses must be advocates for their patients, their families, their colleagues and themselves. Throughout the semester, we will have the chance to learn about the different types of advocacy at multiple levels (patient, unit, region, and nationally) from the nursing perspective.

But nursing doesn't occur in a vacuum, nurses must be able to communicate and collaborate effectively with other people. Teamwork is also essential for effective medical care. We will explore leadership styles, understand how teams function effectively, and explore the principles of effective communication.

At the completion of this course, you will be able to:
Research

   1. Analyze and interpret unit based nursing sensitive quality indicators to monitor outcomes of care processes.

    2. Apply quality improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

    3. Develop a search strategy, complete a comprehensive database search, and identify appropriate citations.

Ethics

    4. Explain the nurse's role in ethically challenging situations and identify resources for help.

Advocacy

   5. Compare and contrast the different roles nurses of play as advocates for their patients, colleagues and themselves.

Leadership

   6. Describe effective functioning within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

COURSE

   7. Critically reflect on how research, ethics, advocacy, and leadership impact on the professional nurse's role.

Assessment and Evaluation

Class Participation/Preparation and Attendance (25%): The REAL courses are discussion-based courses. Its success relies on everyone preparing and actively participating for class, completing assigned readings, contributing to individual or group in-class exercises, and providing constructive peer feedback while 3 actively participating in discussions. Class participation can take on many forms; you and your peers will benefit from thoughtful, respectful in-class dialogue. Your participation will be assessed on class attendance, evaluation of your participation of in-class discussion and exercises, and participation in the class blog.

Quality Improvement Project (30%): Nursing sensitive quality outcomes are one measure of quality specific to the nursing profession. Nursing sensitive quality indicators (NSQI) are those indicators that capture care or its outcomes most affected by nursing care. These indicators have been defined due to the desire for data to show clear linkages between nursing interventions, staffing levels, and positive patient outcomes. The purpose of this assignment is to apply the concepts of quality improvement in this course to interpret unit based NSQI, search the literature to either support or refute care processes that maybe impacting on the outcomes, and either propose potential practice changes or validate continuation of current practice based on the literature. We will be doing exercises throughout the semester to help practice each individual aspects of this assignment with feedback along the way!

Case Studies (30%): In order to apply the concepts discussed, you will have the chance to engage in a total of 3 cases studies that deal with "real world" challenging situations. These case studies will highlight ethical dilemmas, various advocacy roles, and leadership within nursing.

Learning Portfolio (15%): The purpose of this assignment is to reflect on your learning over the semester. To complete the project, you will work individually to create a portfolio of written work to represent your evolving thinking in this course.

Assessment Details

Class Participation (250 pts possible)

Class Attendance: We expect that you will attend class and be an active participant for each class period. You will receive 1 pt/day for attendance and up to 4 pt/day for participation for a total of 140 possible points.Schwartz

Center Rounds: Occur bimonthly LOCATION on emotional discussions on patient safety and ethical issues. Each student will attend 2 Schwartz Center Rounds and write a 1 page reflection of their experience for a total of 20 possible points.

Schwartz Center Rounds: Occur bimonthly LOCATION on emotional discussions on patient safety and ethical issues. Each student will attend 2 Schwartz Center Rounds and write a 1 page reflection of their experience for a total of 20 possible points.

Classroom Blogs: At the end of each week, there will be the opportunity to discuss the topics from the week in an on-line format. Each student will be expected to participate in the on-line discussion four times via our classroom blog at the conclusion of each theme, Research, Ethics, Advocacy, and Leadership. To help you consider what's meaningful to you from each of the themes, by discussing:

  • Amost during about the theme? What was puzzling, intriguing, gratifying, troubling, or upsetting? Why?
  • What specific
  • insight, image, metaphor, passage or concept resonates with you? Why?
  • What do you think is the importance of this theme in nursing?

Your response should be thoughtful, consider class readings, in-class activities, and your peer's posts. Each post is worth 10 possible points for a total of 40 possible points.

Facilitator of Class Blog: You and your group of 5 will be tasked with monitoring the class blog for the week and leading a class discussion on the blog discussion for a total of 50 points possible.

Quality Improvement Project (300 points possible) Healthcare is ever changing. As patients become more complex, technology becomes more advanced, and health care dollars become tighter, the importance of quality outcomes becomes more essential. Specifically, hospitals are being reimbursed, evaluated, and ranked according to quality outcomes. Nursing sensitive quality outcomes are one measure of quality specific to the nursing profession. Nursing sensitive quality indicators (NSQI) are those indicators that capture care or its outcomes most affected by nursing care. These indicators have been defined due to the desire for data to show clear linkages between nursing interventions, staffing levels, and positive patient outcomes. The purpose of this assignment is to apply the concepts learned in this course to interpret unit based NSQI, search the literature to either support or refute care processes that maybe impacting on the outcomes, and either propose potential practice changes or validate continuation of current practice based on the literature.

To complete this project you will work in teams of 3-5 of students to:

  1.  Identify the "quality dashboard data" from your individuals medical/surgical clinical units (10 points). Each inpatient unit at the Health System is required to maintain a standard board (the "quality dashboard") in their team station with updated information regarding unit performance with selected indicators. The adult unit boards display "number of days since last" for catheter-associated infection, catheter associated blood stream infection, and preventable falls, hospital acquired pressure ulcers. The boards are updated monthly for infections, or as occur for falls and hospital acquired pressure ulcers.
    Infections are calculated by: count days since date of last infection from posted raw data on the dashboard, these are updated monthly by last day of month for the prior month's confirmed infection.  Falls are captured by: preventable falls only, update weekly if a fall has occurred with days elapsed since fall occurrence.
     
  2. Compare the unit based results to national benchmark by using the ANA NDNQI website and interpret (20 points).

Is this unit meeting the benchmark? What is the trend over time? Have there been practice changes on the unit that could have affected the data?

  1.  Search the literature to specifically support current practice or identify gaps in practice that may lead to poor outcomes.

    For example, if you are looking at falls on an orthopedic unit, you and your group will develop a search strategy using a variety of databases (Johanna Briggs, Cochrane, Lippincott) to look at the factors associated with falls on orthopedic units. What is or is not happening on your unit that could be contributing to the rate of falls? You will turn in a flow diagram of your search including the number of initial "hits", the method you used to limit the search, and a reference list of the articles you selected (anticipate 3-5 references). (20 points)

  2. Synthesize your findings by writing a proposal including the Ql process (Plan/Do/Check/Act) within the context of your unit dashboard data (anticipate 5-8 pages). Your proposal will focus on the introduction of the issue (ie the "WHY it matters"), your interpretation of the unit based data compared to the national data benchmarks, and finally design a proposal of what you would do or would not do based on the data, support your proposal with evidence from the literature (APA format). Finally you should include how you would assess outcomes after changes in practice are made. (200 points)

I. Introduction (WHY do we care about falls and what are the nurses role) (30points)

II. Unit based-data (15 points)

a. Does this meet the benchmark

b. What are the trends over time

c. What are the surrounding circumstances

III. been shown to decreasefall rate in X population

b. What factors have been show to increase fall rate in X population

IV. Synthesis (100 points)

a. What would you "PLAN" for this unit

b. What would you "DO" for this unit

c. How would you "CHECK" (evaluate) the effectiveness of the changes

d. What would be needed for "ACTION"

V. References/Format (25 points)

Case Studies (300 points possible)

We will work on 3 case studies throughout the semester, each Individual will turn In their response to the case studies; each case study Is worth 100 points. Detailed Instructions will be given prior to starting the case studies, you will begin to work In groups, think aloud problem solving and answer first 3 questions, final question—what would you do? would be answered Individually

Learning Portfolio (150 points possible)

Because the learning portfolio Is meant to be consciously and carefully selective, you should chose up to 2-3 pages of passages selected from your writing, your peers writing, or of others you have Interacted as part of this course. You may have selections from your blog posts, your classmates' blog posts, In-class exercises, course readings or presentations. In fact you should chose passages from those who have Inspired you, but those passages should not exceed >50% of your passages. Your passages should represent each of the 4 components covered In the course (Research, Ethics, Advocacy, Leadership).

The second part of the assignment Is to write your reflective essay (3-5 pages double spaced) explaining what this collection as a WHOLE means to you and how this portfolio reflects the changes In your thinking related to the 4 core components, Research, Ethics, Advocacy and Leadership, as reflected In the course objectives; how they manifest In nursing and how they relate to one another within the field.

Course Policies & Expectations

To be determined on the first day of class

Course Exercises

Ql:

Jigsaw Actlvlty-6 different cases (some with units meeting benchmarks (2)/some who didn't meet benchmarks)

20 mln-ln your group to go through the steps of PDCA 15 mln-jlgsaw 1 person from each group

15 mln-back In your group, would you change based on the feedback

10 mln-Present

Ethics:

Utilize Structured Academic Controversy (Immunizations)?

Leadership:

Role play-play the role In a team assigned by Instructor

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