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Geriatric Innovations in Education: Faculty Development Collaboration Fostering Evidence-Based Nursing Care for Older Adults North Carolina Community College.

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Presentation on theme: "Geriatric Innovations in Education: Faculty Development Collaboration Fostering Evidence-Based Nursing Care for Older Adults North Carolina Community College."— Presentation transcript:

1 Geriatric Innovations in Education: Faculty Development Collaboration Fostering Evidence-Based Nursing Care for Older Adults North Carolina Community College System Conference October 14, 2008

2 Faculty Alexis Welch, RN, EdD Emily Egerton, PhD Loretta Matters, RN, MSN Cindy Archie, EdD, MSN, RN Paula Gribble, RN, MS Eleanor McConnell, RN, PhD, GCNS, BC Director, Duke Center of Excellence for GeriatricNursing EducationClinical Nurse Researcher, Durham Veterans Affairs Medical Center Geriatric Education and Clinical Center

3 Four Part Presentation 1. 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 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 curriculum Evidence-Based approaches to teaching evidence-based careEvidence-Based approaches to teaching evidence-based care 4. Opportunities for ongoing collaboration & impact

4 Origins of Collaboration Story: Story: Duke initially tackled the issue of teaching RNs to practice geriatric care in an evidence-based manner in a one nurse at a time approach.Duke initially tackled the issue of teaching RNs to practice geriatric care in an evidence-based manner in a one nurse at a time approach. Idea: Strategic Partnerships needed to scale up or to impact more nurses/patients so that this becomes standard of careIdea: Strategic Partnerships needed to scale up or to impact more nurses/patients so that this becomes standard of care Multi-level instructional approach of community colleges & the fact that they prepare 60% of the pre-licensure workforce makes them a key partnerMulti-level instructional approach of community colleges & the fact that they prepare 60% of the pre-licensure workforce makes them a key partner HRSA funding made this possible HRSA funding made this possible

5 Societal Need: Proactive, Thinking Nurses How we teach our nurses affects who they become We want nurses who: Meet changing or emerging job expectations and are satisfied in the workplaceMeet changing or emerging job expectations and are satisfied in the workplace Model and teach their own staffModel and teach their own staff Provide appropriate feedback to staff horizontally & verticallyProvide appropriate feedback to staff horizontally & vertically

6 Duke University School of Nursing Clinical Practice Improvement Project Model Developed to allow RNs to strengthen clinical skills and leadership skills, while returning value to the organization Developed to allow RNs to strengthen clinical skills and leadership skills, while returning value to the organization Learn by doing Learn by doing Improved Clinical Leadership in Geriatric Nursing Care Direct Instruction Clinical Content Commun- ication & Feedback Leadership Content Apply & Synthesize CPIP

7 Evidence-based Practice An integration of: Clinical expertiseClinical expertise Patient valuesPatient values Best scientific evidenceBest scientific evidence …..into an informed decision- making process for patient care. …..into an informed decision- making process for patient care.

8 EBP Versus Traditional Approaches EBP TRADITIONAL approaches Clinical expertise Clinical tradition Patient values What seems right Scientifically-based Non-scientific: The best we knew at the time Improved patient care Hoping for patient improvement

9 Cycle of Evidence-based Practice Ask: Pertinent questions in area of uncertainty @ practice Acquire: Best available scientific evidence Appraise: Not all evidence is created equal Apply: Clinical experience and patient preference

10 Scientific Process of EBP For more information: http://www.hsl.unc.edu/services/tutorials/ebm/welcome.htm OR http://www.cebm.utoronto.ca/practise/

11 Case: A Pressure Problem Patient: Mrs Hight is a 93 y.o. woman admitted to your facility several months ago from a nursing home Patient: Mrs Hight is a 93 y.o. woman admitted to your facility several months ago from a nursing home Diagnosis: Stage II pressure ulcer Diagnosis: Stage II pressure ulcer Other problems: CAD, CHF, osteoporosis, CVA. Other problems: CAD, CHF, osteoporosis, CVA. Medications: MS Contin, colace, lasix and ibandronate Medications: MS Contin, colace, lasix and ibandronate Recent Problem: Immobility, constantly wet Recent Problem: Immobility, constantly wet What steps would you take to remedy this situation?

12 Ask What pressure relieving mattress should be used for a 93 y.o. NH resident with a Stage II pressure ulcer? Acquire Pub-Med Search: Select Clinical Queries Pressure sores and elderly Appraise RCT comparing mattress overlays & alternating air pressure mattress (2006) Apply Obtain mattress overlay or alternating pressure mattress

13 Instructional Approach Considers adult learners: Considers adult learners: Learning-oriented Learning-oriented Activity-oriented Activity-oriented Goal oriented Goal oriented Makes learning relevant and purposeful Makes learning relevant and purposeful IOM recommendations, BON rules IOM recommendations, BON rules NLN standards of practice NLN standards of practice Evidence-based, literature based Evidence-based, literature based Creates the nurses the employers expect or want to hire Creates the nurses the employers expect or want to hire Engages students to: Engages students to: Think critically Think critically Consider options for problem-solving or quality improvement Consider options for problem-solving or quality improvement Communicate their needs in a respectful manner Communicate their needs in a respectful manner

14 Diffusion of Innovation The process by which (1) an innovation (2) is communicated through certain channels (3) over time (4) among members of a social system. The process by which (1) an innovation (2) is communicated through certain channels (3) over time (4) among members of a social system. Diffusion is a social process. Diffusion is a social process. Rogers, E., Diffusion of Innovations, 5th ed, 2003.

15 Venn Diagram Behaviorist (teaches what) Constructivist (teaches why) Cognitivist (teaches how) LCI

16 Traditional Vs. Active Learning PassiveActive Reading, watching, listening anothers interaction Analyzing, interacting, discussing, or debating content Simple fact recall Challenges participant to problem solve Memorization Students negotiate, apply and evaluate content

17 The Jigsaw Technique What I hear, I forget. What I hear and see, I remember a little. What I hear, see and ask questions about or discuss, I begin to understand. What I hear, see, discuss and do, I apply. What I teach to another, I master. Chinese Proverb

18 1 A B C D 2 A B C D 3 A B C D 4 A B C D A A A A B B B B C C C C D D D D Jigsaw GroupsExpert Groups

19 Y Concept Maps? Y Water? Activity

20 Assessment Strategies Reflection Journal Reflection Journal One-minute papers One-minute papers Think-pair-share Think-pair-share NCLEX-RN Questions NCLEX-RN Questions

21 Next Steps Opportunities for ongoing collaboration to maximize impact on nursing student education and patient care Why?: University faculty do research – but havent always partnered effectively with those who can make the best use of the researchUniversity faculty do research – but havent always partnered effectively with those who can make the best use of the research Community college faculty dont do the research – but they teach the users of the research, how to find the best evidence and apply it to patient careCommunity college faculty dont do the research – but they teach the users of the research, how to find the best evidence 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

22 Pathways from Strategic Partnership Duke University School of Nursing & NC Community College Nursing Program Leadership GNIE Nurse Educator Institute Learner- Centered Instruction Seminars Deans & Directors Retreat A.D.N. Council NC Board of Nursing New Curriculum Rules CIP


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