Journal of Nursing Education

The articles prior to January 2011 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

Major Articles 

Spiraling Evidence-Based Practice and Outcomes Management Concepts in an Undergraduate Curriculum: A Systematic Approach

Amy Miner Ross, PhD, RN, CNS; Joanne Noone, PhD, FNP; Linda L. Luce, MS, RN; Stephanie A. Sideras, PhD, RN

Abstract

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on the development of evidence-based practice and outcomes management knowledge and skills throughout the nursing curriculum. To this end, seven learning activities were created that spiral and increase in complexity while building on previously acquired skills. Working in teams and practicing team-building techniques, students learned how to develop a clinical question, search the literature, synthesize the current knowledge, identify the significance of the issue in an ecological model, decipher existing quality data and compare that data to national benchmarks, investigate a health care quality issue using quality improvement methods, and draft a proposal for implementation of a continuous quality improvement initiative. Work was presented in both written and oral presentation formats, with emphasis on engaging various audiences in a compelling health care issue.

Abstract

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on the development of evidence-based practice and outcomes management knowledge and skills throughout the nursing curriculum. To this end, seven learning activities were created that spiral and increase in complexity while building on previously acquired skills. Working in teams and practicing team-building techniques, students learned how to develop a clinical question, search the literature, synthesize the current knowledge, identify the significance of the issue in an ecological model, decipher existing quality data and compare that data to national benchmarks, investigate a health care quality issue using quality improvement methods, and draft a proposal for implementation of a continuous quality improvement initiative. Work was presented in both written and oral presentation formats, with emphasis on engaging various audiences in a compelling health care issue.

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on developing evidence-based practice (EBP) and outcomes management knowledge and skills (Greiner & Knebel, 2003). This knowledge and skill development can be introduced and revisited throughout a nursing curriculum rather than the traditional teaching of nursing research within a separate course (Fineout-Overholt, Melnyk, & Schultz, 2005; Greiner & Knebel, 2003). The Institute of Medicine (IOM) has identified five core competencies for health care professionals to achieve to function effectively as clinicians within the 21st century health care system (Greiner & Knebel, 2003) (Table 1):

  • Provide patient-centered care.
  • Work in interdisciplinary teams.
  • Use EBP.
  • Apply quality improvement.
  • Use informatics.

Comparison of OCNE Core Competencies for Undergraduate Nursing Education and IOM Core Competencies for Health Professionals

Table 1: Comparison of OCNE Core Competencies for Undergraduate Nursing Education and IOM Core Competencies for Health Professionals

Background

The Oregon Consortium for Nursing Education (OCNE) is a consortium of public baccalaureate and associate degree nursing programs that developed a nursing curriculum grounded in recommendations from the IOM as well as other national organizing bodies such as SC Colleagues in Caring (2004), Pew Health Professions Commission (1998), Health Resources and Services Administration (2002), and the Joint Commission on Accreditation of Healthcare Organizations (2002) (Gubrud-Howe et al., 2003; OCNE, 2005). Implemented in 2006, the curriculum prepares students to meet 10 core competencies in clinical judgment, EBP, collaboration, systems thinking in leadership, and culturally appropriate relationship-centered care (Gubrud-Howe et al., 2003; OCNE, 2005) (Table 1). The 10 competencies have three levels of benchmarks to be met during the 3-year clinical program (OCNE, 2005). In this curriculum, students begin taking nursing courses in their sophomore year after completing 1 year of general education prerequisites.

Concepts Defined

Spiral Curriculum Structure

A constructivist approach to learning using intentional spiraling of increasing complex learning activities is the framework for this OCNE curriculum (Smith, 2002). A spiral curriculum assumes learners will be ready and motivated to learn, and will seek higher or more complex levels of knowledge meaningful to their professional goals using intuitive and analytical thinking (Smith, 2002). The attributes of the spiral curriculum are where repeated experience, practice, and critical examination of both the common and the contrasted core content are presented to students with increased complexity in each revisitation (Phelps, n.d.). Students elaborate on previous topics while building competency and mastery of expected learning outcomes (Davis, 2003; Davis & Harden, 2003; Harden, 1999).

In addition to the spiral curriculum framework, this series of assignments was designed to engage, motivate, and promote learning for understanding by enhancing the transfer of acquired skills related to EBP, teamwork, interprofessional collaboration, and outcomes management from the academic environment to the practice setting (Bransford, Brown, & Cocking, 2000; D’Eon, 2005). For example, the learning activities were aimed at content principles (e.g., how to search a database, how to write a research question), and the student practice was directed toward application of the content principles with the context of a specific problem or patient population.

EBP and Outcomes Management

For health care professionals in the 21st century, being knowledgeable about and engaged in EBP and outcomes management are essential IOM and OCNE competencies (Greiner & Knebel, 2003; OCNE, 2005) (Table 1). The process of EBP consistently applies a synthesis of the latest research, evidence-based guidelines, clinical expertise, and judgment in decision making related to the needs of patients or clinical populations (Fineout-Overholt et al., 2005). In addition, the EBP process includes continuous management system-focused outcome evaluation of the applied EBP process in the health care setting (i.e., outcomes management) (Fineout-Overholt et al., 2005). Educational research has shown EBP and outcomes management skills can be integrated throughout the curriculum using a variety of learning opportunities in academic (i.e., posters, oral presentations, reports) and practice settings (i.e., acute care, chronic care, and clinical system work groups) (Green & Ellis, 1997; Norman & Shannon, 1998).

Teamwork and Interprofessional Collaboration

Both the IOM (Greiner & Knebel, 2003) and the American Association of Colleges of Nursing (1998) describe teamwork as an essential skill for nursing. Interprofessional collaboration is an attribute of successful safety initiatives and quality improvement activities (Greiner & Knebel, 2003; Ladden, Bednash, Stevens, & Moore, 2006). The IOM and OCNE competencies pertaining to collaborating in interprofessional teams (Table 1) are also foundational to developing and sustaining strides in quality in health care delivery (i.e., EBP and outcomes management) (Greiner & Knebel, 2003; OCNE 2005). It is estimated that 97% of health care institutions use a team-based approach (Manion, Lorimer, & Leander, 1996). Working collaboratively in interprofessional teams is a major way that nursing influences care delivery in health care settings (Dailey, 2005; Long, Kneafsey, Ryan, & Berry, 2002; Stepans, Thompson, & Buchanan, 2002). In a survey of more than 10,000 nurses, higher teamwork scores, measured on a Nursing Workload Index, were significantly associated with job satisfaction and decreased burnout (Rafferty, Ball, & Aiken, 2001). Providing opportunities to work within diverse teams in an academic environment can develop teamwork and collaboration skills that serve as a foundation for later application of teamwork in the clinical arena (Michaelsen, Knight, & Fink, 2004).

To spiral the concepts evolving from EBP to clinical outcomes management, seven learning activities were developed that reside in each quarter of the program of study. After assignments are completed, the majority are presented in a public setting, either to the current level class, the school of nursing, the university community, or to others in practice settings. This public sharing enhances learning from others who have had practice setting opportunities that cannot be experienced by all students and also allows all of the students to develop the same skill set. In addition, these public presentations allow students to dialogue with expert nurses while communicating complex ideas and issues. This article describes teaching evidence-based nursing practice throughout a nursing curriculum designed to prepare nurses to practice in the 21st century.

Summary of the Learning Activities

First-Year Learning Activities

The first-year clinical nursing courses that students take as sophomores include Health Promotion and Assessment, followed by Chronic Illness I and Acute Care I. During the first year, assignments in each course were developed that built beginning concepts of EBP and team-work skills. Newly created rubrics for all assignments help guide the students in the project and are used for numeric grading of all summative evaluations.

Orientation and Expectations. The initial focus is on developing foundational skills for locating and evaluating sources of evidence. All students attend a library orientation that presents information about online database searching. Students have access to an electronic tutorial to refer to throughout the rest of the program. Expectations are set related to formatting professional citations. Embedded as part of multiple assignments are opportunities for skill building in online data searching and retrieval. For example, journal readings are assigned by providing selected aspects of the citation, such as topic of article, name of author, and year of publication, requiring students to use various methods to retrieve articles available in the online library databases.

Assignment 1. The first stand-alone assignment for EBP in this foundational year occurs within the context of developing a health plan for a middle-aged adult. After identifying an area for behavior change, students follow a tutorial to aid them in developing a clinical question in the PICO format (Population, Intervention, Comparison, and Outcome) (Fineout-Overholt et al., 2005). Students then search for a research article and a clinical guideline that provide information in answering the developed clinical question. The students complete a tutorial designed by the faculty to assist them in analyzing the research article to begin to develop an understanding of research design and identification of research questions, implications, and limitations. Students provide the search terms and databases used in this process. Students are given feedback on their research review and proper citation of the research article and clinical guideline.

Assignment 2. In spiraling and building on foundational EBP skills and beginning development in team skills, subsequent assignments during the year are focused on continuing development in online database searching to answer clinical questions, evaluation of levels of evidence (Fineout-Overholt et al., 2005), and beginning scholarly dissemination through a poster presentation. Working in teams, students are assigned a chronic illness for the duration of the course and investigate the chronic illness pathology, the effects of the illness on patients, resources within the local community, costs of the illness, and one complementary and alternative method used by individuals with the illness. The teams are built to include a diversity of age, gender, ethnic background, and health care experience (Michaelsen et al., 2004). For the EBP part of this assignment, students select one complementary and alternative method and perform a literature search and assess levels of evidence to support or refute its efficacy for the selected illness.

Increased numbers of references are expected, as well as mastery of citation formatting. Resources are provided for students to prepare a poster presentation. A class session at the end of the term is set aside to mirror the experience of presenting posters at a professional conference. Students are expected to set up and attend their poster, answer questions, and dialogue about the illnesses. Other students in the course and the course faculty are the target audience for the poster presentation. Students are evaluated on the evidence presented and their professionalism. Team-building skills are included throughout the associated course and include team tests and peer evaluation. One component of the poster evaluation grade is based on the assessment of the contribution of the individual member by the rest of the team (Michaelsen et al., 2004). A grading rubric as recommended by Stevens and Levi (2004) is used to guide completion of the assignment.

Assignment 3. Evidence-based practice concepts and team-building skills are revisited and spiraled from chronic illness to the acute care population and issues. Team assignment and poster presentation are used again to reinforce these concepts and to provide another opportunity to work with a different team. The assignment is to develop a clinical question to uncover best practices in an acute care setting. The assignment has sequential modules that provide faculty guidance and feedback as students develop and refine their question, search the literature, and select current, relevant primary research to answer their question. Students present their findings with conclusions and clinical practice implications in a poster presentation at the end of the quarter. This presentation is open to all students and faculty within the school of nursing, spiraling up the complexity of the presentation. Evaluation of this assignment is similar to the grading criteria for the chronic illness assignment.

Second-Year Learning Activities

During the second or junior year of the program, three assignments are included as part of the Chronic Care II, Acute Care II, and Population courses. These three assignments spiral from the EBP content and teamwork skills, transitioning students to consider the impact of clinical outcomes in a population context. Spiraling concepts from the first year that are revisited include database searching, assessment of evidence, reference building in a concept area, and presentation skills. Initial assignments are formative, building skills to work with existing data from national databases, learning continuous quality improvement methods, and applying evidence-based epidemiological data to build a case for the significance of a practice issue.

Assignment 4. The first assignment of the second year is based in a group discussion and has students explore decision making processes of chronically ill patients facing acute hospitalization. Students obtain current data from the national benchmarking database Web site Hospital Compare of the U.S. Department of Health and Human Services (n.d.) as well as the in-state mortality data for the hospitals in their region (i.e., state Department of Health and Human Services). The students search for pneumonia and total hip replacement performance measures from the Hospital Compare Web site and mortality rates from their state, and develop information for comparison and decision making for their case study patient, who is either an immunocompromised cancer patient or a patient with hip arthritis.

The learning foci for this assignment are comparing the rates of best practice care for these two populations in a designated catchment area, deciding what kind of information to bring to the nurse-patient dialogue after reviewing these data, and selecting the proper quality indicator comparisons and hospital selection criteria to point out to the nurse’s patient and the rationale. This is a formative discussion that can be conducted either in the classroom setting or online with faculty fostering discussion that brings out multiple facets in providing clients with accurate information on which to base care decisions; students are not formally evaluated for this assignment.

Assignment 5. The next assignment in the second year contains four modules and is based in the acute care clinical seminar. Students compare real-time best practice with best practice guidelines for a number of preset skills, protocol, or evidence-based guidelines in the acute care clinical environment. Students identify the problem; search for best practice guidelines and hospital policies; conduct an audit process on actual practice; and report the results to the facility, faculty, and classmates with an emphasis on recommendations for practice.

The learning foci for this assignment are skills for continuous quality improvement methods: best practice compliance, or tracer methods to assess system processes or rare high-risk low-frequency events. For example, students might compare best practice guidelines related to central-line dressing changes with hospital policy and observed actual practice in the acute care setting using compliance methods. Students are mentored by faculty and practice partners with final presentation of the findings to the facility, and to classmates and faculty in the school of nursing, with options for PowerPoint® or poster presentation and evaluation by rubric specific to the assignment.

Assignment 6. The third assignment of the second year is a one-page significance paragraph assignment, which is part of a larger assignment that assesses the community as a health setting. Significance statements serve as a force to motivate readers to understand the health care issue as a broad-reaching societal burden (e.g., overuse of scarce resources). To describe the incidence and financial impact of the health issue and to create a broad picture of societal burden, students search for government-level data (e.g., state health demographics and statistics), as well as data from professional organizations (e.g., Heart Facts from the American Heart Association), other Web sites, and the literature. The presentation of these data needs to reflect the contexts (i.e., individual, family, community, and society) and relationships (e.g., individual and family, individual and community, and family and society relationships) evident in ecological modeling (Bubolz & Sontag, 1993). This assignment is evaluated as a part of the larger community assessment paper.

Third-Year Learning Activities

During the third or senior year of the program, there are three courses: Leadership and Outcomes Management, and two consecutive Clinical Immersion courses. There is one comprehensive three-part assignment, the Leadership Outcomes Project (LOP) proposal, which is part of the Leadership course. The LOP proposal is a competency demonstration of the concepts of EBP and clinical outcomes management by a nurse leader. This assignment is designed to be adaptable to a variety of clinical, agency, or community-based settings. Variable elective credit may be assigned for implementation and evaluation of the LOP proposal during the two final Clinical Immersion courses, thus creating an optional senior thesis opportunity.

Assignment 7. The LOP proposal assignment develops and supports students as team members in an interprofessional environment as they work with others in a practice setting to provide a tangible product to the organization providing clinical placement. This assignment provides demonstration of multiple competencies at once, as well as the chance to use acquired skills and knowledge to solve a real practice issue. Core content and method support for this assignment will be provided in a series of clinical seminars scheduled to coincide with the stages of the LOP proposal assignment. Formative evaluation is provided during the process of developing the LOP proposal.

This assignment, also serving as a competency demonstration, has three sequential modules. The first module is a written report identifying a systems problem that requires a change process with the stakeholders involved, a preliminary cost analysis based on available organizational data, a comparison of existing data collected to appropriate benchmarks, and the identification of the beginning steps and use of tools for a continuous quality improvement process. The second module contains a revised first report with the addition of the definitions of measurable concepts and goals, as well as suggested methods for practical immediate and ongoing data collection. The third module again contains the revised previous reports and additional plans for implementing the change process, implementation scheme for the content of the continuous quality improvement project in a real-world setting including a system-wide intervention, identification of the cost analysis evaluation components to be used after the intervention is implemented in an ongoing and timely manner, and the evaluation scheme that is goal based and grounded to a time line. The final product is to be presented either to the facility or to the faculty and class in a PowerPoint presentation with emphasis on framing the issue to be appropriate for the intended audience as well as the political climate and culture of the clinical site.

The paramount outcome for this assignment is to present a deliverable (i.e., tangible) product to the hosting facility. This can be as simple as an organized literature review, as time and work flow constraints in the hosting facility may preclude the formal presentation of this product to all of the stakeholders at one time. Overall evaluation of the completion of the competency demonstration is evaluated by rubric and is not dependent on students successfully gaining acceptance of the proposal by the facility or stakeholders. If students elect to remain in the same clinical setting for the two following intensive Clinical Immersion courses, there are course outcomes (Table 2) that could be satisfied by continuing to take a leadership role as the quality project progresses by garnering faculty and facility support with a formal proposal.

Summary of Learning Activities, Competencies and Program Benchmarks, Concept and Skill Focus, and Evaluation Methods Summary of Learning Activities, Competencies and Program Benchmarks, Concept and Skill Focus, and Evaluation Methods Summary of Learning Activities, Competencies and Program Benchmarks, Concept and Skill Focus, and Evaluation Methods

Table 2: Summary of Learning Activities, Competencies and Program Benchmarks, Concept and Skill Focus, and Evaluation Methods

Conclusion

These assignments were developed based on particular course content (i.e., health promotion, chronic care, acute care, population science, and leadership) and competencies and level benchmarks (Table 2). Graduates begin their nursing career with developing skills in:

  • Identifying a clinical question for investigation.
  • Searching databases.
  • Assessing the levels of evidence for best practice.
  • Synthesizing evidence.
  • Working in teams on practice projects.
  • Interpreting existing quality data and data collection methods.
  • Giving professional oral and written presentations. This format can be replicated within different courses and program curricula through identification of competencies to be achieved and concepts to be spiraled. In a curriculum with a set program of study, these assignments use creative means to embed EBP and outcomes management content and skills, as well as building and fostering enduring understandings and sustainable capabilities in health professionals for the 21st century.

References

  • American Association of Colleges of Nursing. (1998). The essentials of baccalaureate nursing education for professional nursing practice. Retrieved January 23, 2008, from http://www.aacn.nche.edu/Education/pdf/BaccEssentials98.pdf
  • Bransford, J.D., Brown, A.L. & Cocking, R.R. (Eds.). (2000). How people learn: Brain, mind, experience, and school. Washington, DC: National Academy Press.
  • Bubolz, M.M. & Sontag, M.S. (1993). Human ecology theory. In Boss, P.G., Doherty, W.J., LaRossa, R., Schumm, W.R. & Steinmetz, S.K. (Eds.), Sourcebook of family theories and methods: A contextual approach (pp. 419–447). New York: Springer.
  • Dailey, M. (2005). Interdisciplinary collaboration: Essential for improved wound care outcomes and wound prevention in home care. Home Health Care Management & Practice, 17, 213–221. doi:10.1177/1084822304271808 [CrossRef]
  • Davis, M.H. (2003). OSCE: The Dundee experience. Medical Teacher, 25, 255–261. doi:10.1080/0142159031000100292 [CrossRef]
  • Davis, M.H. & Harden, R.M. (2003). Planning and implementing an undergraduate medical curriculum: The lessons learned. Medical Teacher, 25, 596–608. doi:10.1080/0142159032000144383 [CrossRef]
  • D’Eon, M. (2005). A blueprint for interprofessional learning. Journal of Interprofessional Care, 19(Suppl. 1), 49–59. doi:10.1080/13561820512331350227 [CrossRef]
  • Fineout-Overholt, E., Melnyk, B.M. & Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing, 21, 335–344. doi:10.1016/j.profnurs.2005.10.005 [CrossRef]
  • Green, M.L. & Ellis, P.J. (1997). Impact of an evidence-based medicine curriculum based on adult learning theory. Journal of General Internal Medicine, 12, 742–750. doi:10.1046/j.1525-1497.1997.07159.x [CrossRef]
  • Greiner, A.C. & Knebel, E. (Eds.). (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.
  • Gubrud-Howe, P., Shaver, K.S., Tanner, C.A., Bennett-Stillmaker, J., Davidson, S.B. & Flaherty-Robb, M. et al. (2003). A challenge to meet the future: Nursing education in Oregon, 2010. Journal of Nursing Education, 42, 163–167.
  • Harden, R.M. (1999). What is a spiral curriculum?Medical Teacher, 21, 141–143. doi:10.1080/01421599979752 [CrossRef]
  • Health Resources and Services Administration, Bureau of Health Professions. (2002). The registered nurse population: Findings from the 2000 National Sample Survey of Registered Nurses. Retrieved January 19, 2009, from http://bhpr.hrsa.gov/healthworkforce/reports/nursing/samplesurvey00/default.htm
  • Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis. Retrieved April 28, 2008, from http://www.jointcommission.org/PublicPolicy/nurse_staffing.htm
  • Ladden, M.D., Bednash, G., Stevens, D.P. & Moore, G.T. (2006). Educating interprofessional learners for quality, safety, and systems improvement. Journal of Interprofessional Care, 20, 497–505. doi:10.1080/13561820600935543 [CrossRef]
  • Long, A.F., Kneafsey, R., Ryan, J. & Berry, J. (2002). The role of the nurse within the multi-professional rehabilitation team. Journal of Advanced Nursing, 37, 70–78. doi:10.1046/j.1365-2648.2002.02059.x [CrossRef]
  • Manion, J., Lorimer, W. & Leander, W.J. (1996). Team-based health care organizations: Blueprint for success. Gaithersburg, MD: Aspen.
  • Michaelsen, L.K., Knight, A.B. & Fink, L.D (Eds.). (2004). Team-based learning: A transformative use of small groups in college teaching. Sterling, VA: Stylus.
  • Norman, G.R. & Shannon, S.I. (1998). Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: A critical appraisal. Canadian Medical Association Journal, 158, 177–181.
  • Oregon Consortium for Nursing Education. (2005). Welcome. Retrieved February 18, 2008, from http://www.ocne.org
  • Pew Health Professions Commission. (1998). Twenty-one competencies for the 21st century. Retrieved January 19, 2009, from http://www.futurehealth.ucsf.edu/pewcomm/competen.html
  • Phelps, L.W. (n.d.). General principles and the spiral curriculum. Retrieved February 12, 2008, from http://wrt.syr.edu/pub/spiral.html
  • Rafferty, A.M., Ball, J. & Aiken, L.H. (2001). Are teamwork and professional autonomy compatible, and do they result in improved hospital care?Quality in Health Care, 10(Suppl. 2), ii32–ii37.
  • SC Colleagues in Caring. (2004). Colleagues in caring: Regional collaboratives for nursing work force development. Retrieved January 19, 2009, from http://www.rwjf.org/reports/npreports/colleagues.htm
  • Smith, M.K. (2002). Jerome S. Bruner and the process of education. The encyclopedia of information education. Retrieved February 12, 2008, from http://www.infed.org/thinkers/bruner.htm
  • Stepans, M.B., Thompson, C.L. & Buchanan, M.L. (2002). The role of the nurse on a transdisciplinary early intervention assessment team. Public Health Nursing, 19, 238–245. doi:10.1046/j.1525-1446.2002.19403.x [CrossRef]
  • Stevens, D.D. & Levi, A.J. (2004). Introduction to rubrics: An assessment tool to save grading time, convey effective feedback and promote student learning. Sterling, VA: Stylus.
  • U.S. Department of Health and Human Services. (n.d.). Hospital compare: A quality tool for adults, including people with Medicare. Retrieved February 12, 2008, from http://www.hospitalcompare.hhs.gov

Comparison of OCNE Core Competencies for Undergraduate Nursing Education and IOM Core Competencies for Health Professionals

OCNE IOM
1. A competent nurse’s personal and professional actions are based on a set of shared core nursing values (IOM 1) 1. A competent health professional provides patient-centered care
2. A competent nurse develops insight through reflection, self-analysis, and self-care (IOM 1) 2. A competent health professional is able to work in interdisciplinary teams
3. A competent nurse engages in ongoing self-directed learning (IOM 3) 3. A competent health professional uses evidence-based practice
4. A competent nurse demonstrates leadership in nursing and health care (IOM 4) 4. A competent health professional applies quality improvement
5. A competent nurse collaborates as part of a health care team (IOM 2) 5. A competent health professional uses informatics
6. A competent nurse practices within, uses, and contributes to the broader health care system (IOM 2, 4, and 5)
7. A competent nurse practices relationship-centered care (IOM 1)
8. A competent nurse communicates effectively (IOM 2)
9. A competent nurse makes sound clinical judgments (IOM 3)
10. A competent nurse, in making practice decisions, locates, evaluates, and uses the best available evidence (IOM 3, 4, and 5)

Summary of Learning Activities, Competencies and Program Benchmarks, Concept and Skill Focus, and Evaluation Methods

Learning Activity Course OCNE Program Benchmark Focus: Concept Base and Skill Building Evaluation Method
First year
  Online journal readings, searching tutorials Health Promotion and Assessment Competency 10: able to independently find literature in one database assignment Searching databases and electronic retrieval Tutorial completion
  Health plan referencing and research review Health Promotion and Assessment Competency 10: reads and summarizes integrative reviews and clinical practice guidelines; looks for supporting evidence for nursing interventions Developing clinical question for health plan, finding supporting evidence, correct citation and analysis of research Selection of appropriate research and guideline for health plan, correct citation, research review tutorial completion
  Evaluating evidence for single complementary or alternative therapy for chronic illness Chronic Illness I Competency 5: consults and collaborates with own peers, faculty, and nursing staff; demonstrates ability to fulfill assignments and commitments; Competency 10: Can conduct broad database search using digital retrieval systems, including the Internet; identifies potential implications for practice from integrative reviews and clinical guidelines Database searching, electronic retrieval, evaluation of evidence, correct citation, professional presentation and dialogue Team poster presentation to class and class faculty, poster presentation rubric
  Developing clinical questions for best practices in acute care, finding evidence to answer question Acute Care I Same as above Developing clinical question, database searching, electronic retrieval, evaluation of evidence, correct citation, professional presentation and dialogue Team poster presentation to nursing school and faculty, poster presentation rubric
Second year
  Evaluating and choosing health care facilities based on existing continuous quality improvement data Chronic Illness II Competency 6: uses and contributes to patient centered resource utilization within the larger health care system; Competency 7: practices relationship-centered care decision making; Competency 10: locates, evaluates, and uses best available nationally benchmarked evidence in shared decision making with patients Evidence-based practice, continuous quality improvement data evaluation from existing data Discussion participation rubric as part of whole course evaluation
  Evaluation of evidence-based best practice skills, guidelines, or processes Acute Care II Competency 5: collaborates with members of the health care team to evaluate current nursing practice; Competency 10: locates and evaluates existing data, collects current best-practice data in a real-time setting to evaluate real-time care against national best-practice skills, protocols, or guidelines Evidence-based practice, continuous quality improvement methods skill building, tracer and compliance methods, data collection Poster presentation; PowerPoint® presentation to agency
  Significance paragraph Population Science Competency 10: locates, evaluates, and uses best available data from region, state, and nation to support significance and case building for a pertinent health care issue Synthesis of existing data to be able to describe a population-based issue and make a compelling statement of need Section of larger population assessment in a community setting, paper
Third year
  Leadership outcomes project, proposal Leadership and Outcomes Management Competency 4: leads team to identify continuous quality improvement issue, stakeholder, assess existing continuous quality improvement data; Competency 5: collaborates with members of the health care team to propose continuous quality improvement implementation; Competency 8: uses effective communication strategies to present current state of continuous quality improvement issue to a larger system; Competency 10: locates, evaluates, and uses best available nationally benchmarked existing data to propose continuous quality improvement process Identification of issue and stakeholders, team charter creation, assessment of current practice and cost analysis from existing systems data, definition of concepts and measures, goal statement, plans for scheme for change management, implementation, and evaluation, dissemination of results to project facility, faculty, and classmates PowerPoint presentation of proposal, paper
  Leadership outcomes project, implementation Clinical Immersion I Competency 3: demonstrates commitment and engages in new and ongoing self-directed learning opportunities; Competencies 4, 5, and 8: uses effective communication strategies to collaborate with and lead teams to implement continuous quality improvement project, empowers others—especially those who hold different points of view Implementation of proposed continuous quality improvement project PowerPoint presentation of interim work to date, paper
  Leadership outcomes project, evaluation Clinical Immersion II Competency 3: same as above; Competencies 4, 5, and 8: same as above, with the focus on evaluation and empowerment of others through dissemination of newly created data Evaluation of continuous quality improvement project PowerPoint presentation of final report, paper
Authors

Dr. Ross and Ms. Luce are Assistant Professors, Oregon Health & Science University, Portland, and Drs. Noone and Sideras are Assistant Professors, Oregon Health & Science University, Ashland, Oregon.

The authors thank their colleagues and Oregon Consortium for Nursing Education faculty partners for their contributions in the development of learning activities, and in particular Rene Menkens, MS, RN, Nursing Faculty, Southwestern Oregon Community College.

Address correspondence to Amy Miner Ross, PhD, RN, CNS, 1250 Siskiyou Boulevard, Ashland, OR 97520; e-mail: rossam@ohsu.edu.

Received: October 12, 2007
Accepted: June 24, 2008
Posted Online: March 27, 2009

10.3928/01484834-20090515-04

Sign up to receive

Journal E-contents