Geriatric Innovations in Education: Faculty Development Collaboration Fostering Evidence-Based Nursing

Care for Older Adults

North Carolina Community College North Carolina Community College System ConferenceSystem Conference

October 14, 2008October 14, 2008

FacultyAlexis Welch, RN, EdDAlexis Welch, RN, EdD

Emily Egerton, PhDEmily Egerton, PhDLoretta Matters, RN, MSNLoretta Matters, RN, MSN

Cindy Archie, EdD, MSN, RNCindy Archie, EdD, MSN, RNPaula Gribble, RN, MSPaula Gribble, RN, MS

Eleanor McConnell, RN, PhD, GCNS, BCEleanor McConnell, RN, PhD, GCNS, BCDirector, Duke Center of Excellence for GeriatricNursing Director, Duke Center of Excellence for GeriatricNursing

EducationClinical Nurse Researcher, Durham Veterans Affairs EducationClinical Nurse Researcher, Durham Veterans Affairs Medical Center Geriatric Education and Clinical CenterMedical Center Geriatric Education and Clinical Center

Four Part Presentation1. How & why did partnership occur1. How & why did partnership occur

• University-based driversUniversity-based drivers• Community College-based driversCommunity College-based drivers• Societal needSocietal need• Evidence-based v. Best practiceEvidence-based v. Best practice

2. Approach to instruction2. Approach to instruction• Adult education principlesAdult education principles• Integration of Diffusion of InnovationIntegration of Diffusion of Innovation• Venn Diagram of training modelVenn Diagram of training model

3. Integration into curriculum3. Integration into curriculum• Evidence-Based approaches to teaching evidence-based Evidence-Based approaches to teaching evidence-based

carecare

4. Opportunities for ongoing collaboration & impact4. Opportunities for ongoing collaboration & impact

Origins of Collaboration

Story:Story:• Duke initially tackled the issue of teaching RNs Duke initially tackled the issue of teaching RNs

to practice geriatric care in an evidence-based to practice geriatric care in an evidence-based manner in a “one nurse at a time” approach.manner in a “one nurse at a time” approach.

• Idea: Strategic Partnerships needed to scale Idea: Strategic Partnerships needed to scale up or to impact more nurses/patients so that up or to impact more nurses/patients so that this becomes standard of carethis becomes standard of care

• Multi-level instructional approach of Multi-level instructional approach of community colleges & the fact that they community colleges & the fact that they prepare 60% of the pre-licensure workforce prepare 60% of the pre-licensure workforce makes them a key partnermakes them a key partner

HRSA funding made this possibleHRSA funding made this possible

Societal Need: Proactive, Thinking Nurses

How we teach our nurses affects How we teach our nurses affects who they becomewho they become

We want nurses who:We want nurses who:• Meet changing or emerging job Meet changing or emerging job

expectations and are satisfied in the expectations and are satisfied in the workplaceworkplace

• Model and teach their own staffModel and teach their own staff• Provide appropriate feedback to staff Provide appropriate feedback to staff

horizontally & verticallyhorizontally & vertically

Duke University School of Nursing Clinical Practice Improvement Project Model

Developed to allow RNs to strengthen Developed to allow RNs to strengthen clinical skills and leadership skills, while clinical skills and leadership skills, while returning value to the organizationreturning value to the organization

Learn by doingLearn by doing

Improved Clinical Leadership in Geriatric Nursing Care

Direct Instruction

ClinicalContent

Commun-ication & Feedback Leadership Content

Apply & Synthesize

CPIP

Evidence-based Practice

An integration of:An integration of:• Clinical expertiseClinical expertise• Patient valuesPatient values• Best scientific evidenceBest scientific evidence

……..into an informed decision-..into an informed decision-making process for patient care.making process for patient care.

EBP Versus Traditional Approaches

EBPEBP TRADITIONAL TRADITIONAL approachesapproaches

Clinical expertiseClinical expertise Clinical traditionClinical tradition

Patient valuesPatient values What seems rightWhat seems right

Scientifically-basedScientifically-based Non-scientific: The Non-scientific: The best we knew at the best we knew at the timetime

Improved patient Improved patient carecare

Hoping for patient Hoping for patient improvementimprovement

Cycle of Evidence-based Practice

Ask:Ask: Pertinent questions in area of Pertinent questions in area of uncertainty @ practiceuncertainty @ practice

Acquire:Acquire: Best available scientific Best available scientific evidenceevidence

Appraise:Appraise: Not all evidence is created Not all evidence is created equalequal

Apply:Apply: Clinical experience and Clinical experience and patient preferencepatient preference

Scientific Process of EBP

For more information:

http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htmORhttp://www.cebm.utoronto.ca/practise/

Case: A Pressure Problem Patient:Patient: Mrs Hight is a 93 y.o. woman Mrs Hight is a 93 y.o. woman

admitted to your facility several months ago admitted to your facility several months ago from a nursing homefrom a nursing home

Diagnosis:Diagnosis: Stage II pressure ulcer Stage II pressure ulcer Other problems:Other problems: CAD, CHF, osteoporosis, CAD, CHF, osteoporosis,

CVA.CVA. Medications:Medications: MS Contin, colace, lasix and MS Contin, colace, lasix and

ibandronateibandronate Recent Problem:Recent Problem: Immobility, constantly wet Immobility, constantly wet

What steps would you take to remedy What steps would you take to remedy this situation?this situation?

Ask What pressure relieving What pressure relieving mattress should be used for a mattress should be used for a 93 y.o. NH resident with a Stage 93 y.o. NH resident with a Stage II pressure ulcer?II pressure ulcer?

Acquire Pub-Med Search: Pub-Med Search: Select Clinical QueriesSelect Clinical Queries

Pressure sores and elderlyPressure sores and elderly

Appraise RCT comparing mattress RCT comparing mattress overlays & alternating air overlays & alternating air pressure mattress (2006)pressure mattress (2006)

ApplyApply Obtain mattress overlay or Obtain mattress overlay or alternating pressure mattressalternating pressure mattress

Instructional Approach Considers adult learners:Considers adult learners:

Learning-orientedLearning-oriented Activity-orientedActivity-oriented Goal orientedGoal oriented

Makes learning relevant and purposefulMakes learning relevant and purposeful IOM recommendations, BON rulesIOM recommendations, BON rules NLN standards of practiceNLN standards of practice Evidence-based, literature basedEvidence-based, literature based Creates the nurses the employers expect or want to Creates the nurses the employers expect or want to

hirehire Engages students to:Engages students to:

Think criticallyThink critically Consider options for problem-solving or quality Consider options for problem-solving or quality

improvementimprovement Communicate their needs in a respectful mannerCommunicate their needs in a respectful manner

Diffusion of Innovation

The process by which (1) an The process by which (1) an innovationinnovation (2) is (2) is communicatedcommunicated through through certain channelscertain channels (3) over (3) over timetime (4) among (4) among membersmembers of a of a socialsocial systemsystem..

Diffusion is a Diffusion is a social processsocial process..

Rogers, E., Diffusion of Innovations, 5th ed, 2003.Rogers, E., Diffusion of Innovations, 5th ed, 2003.

Venn Diagram

BehavioristBehaviorist

(teaches what)(teaches what)

ConstructivistConstructivist

(teaches why)(teaches why)

Cognitivist Cognitivist

(teaches how)(teaches how)

LCILCI

Traditional Vs. Active Learning

PassivePassive ActiveActive

Reading, watching, Reading, watching, listening another’s listening another’s interactioninteraction

Analyzing, Analyzing, interacting, interacting, discussing, or discussing, or debating contentdebating content

Simple fact recallSimple fact recall Challenges Challenges participant to participant to problem solveproblem solve

MemorizationMemorization Students negotiate, Students negotiate, apply and evaluate apply and evaluate contentcontent

The Jigsaw Technique

What IWhat I hearhear, I, I forgetforget..

What IWhat I hearhear andand seesee, I, I remember a littleremember a little..

What IWhat I hearhear,, seesee andand ask questionsask questions aboutabout oror discussdiscuss, , I begin toI begin to understandunderstand..

What IWhat I hearhear,, seesee,, discussdiscuss andand dodo, I, I applyapply..

What IWhat I teachteach to another, Ito another, I mastermaster..

Chinese ProverbChinese Proverb

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Jigsaw Groups Expert Groups

“Y” Concept Maps?

“Y” Water? Activity

Assessment Strategies

Reflection JournalReflection Journal One-minute papersOne-minute papers Think-pair-shareThink-pair-share NCLEX-RN QuestionsNCLEX-RN Questions

Next StepsOpportunities for ongoing collaboration to

maximize impact on nursing student education and patient care

Why?:• University faculty do research – but haven’t always University faculty do research – but haven’t always

partnered effectively with those who can make the best partnered effectively with those who can make the best use of the research use of the research

• Community college faculty don’t do the research – but they Community college faculty don’t do the research – but they teach the users of the research, how to find the best teach the users of the research, how to find the best evidence and apply it to patient careevidence and apply it to patient care

How?How?• CoE-GNIE Learning Object RepositoryCoE-GNIE Learning Object Repository• Use nursing program advisory boards to promote EBPUse nursing program advisory boards to promote EBP• Get practice leaders and nurse educators involved in GNIEGet practice leaders and nurse educators involved in GNIE• Education leaders Co-learning environmentEducation leaders Co-learning environment

Pathways from Strategic Partnership

Duke University School of Nursing &

NC Community CollegeNursing Program

Leadership

GNIE NurseEducator Institute

Learner-Centered Instruction Seminars

•Deans & Directors’

Retreat•A.D.N. Council

NC Board of NursingNew Curriculum Rules

CIP