Discuss EVERY AACN BSN ESSENTIAL and describe in great detain how you met each essential with specific examples. For every AACN BSN Essential y

Faculty Tool Kit

NURSE FACULTY TOOL KIT FOR THE IMPLEMENTATION OF THE BACCALAUREATE ESSENTIALS

February 19, 2009

Table of Contents Page Overview 2 Integrative Learning Strategies 3 Essential I 4 Essential II 4 Essential III 5 Essential IV 6 Essential V 6 Essential VI 7 Essential VII 8 Essential VIII 8 Essential IX 10 Opportunities for Program Enhancement 11 Helpful Web links, including Stakeholders 19 AACN Presentations 22 References/Bibliography 23

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OVERVIEW

The purpose of the Baccalaureate Essentials Tool Kit is to provide resources and exemplars to assist faculty with the implementation of the Essentials of Baccalaureate Education for Professional Nursing Practice (2008). The tool kit provides integrative learning strategies, opportunities for program enhancement, and resources that will assist faculty with the integration of the Baccalaureate Essentials throughout the nursing curriculum. This tool kit includes a review of the nine Baccalaureate Essentials followed by Integrative Learning Strategies, Opportunities for Program Enhancement, Web Links, AACN Presentations, and References. Baccalaureate Essentials Essentials I through IX delineate the outcomes expected of graduates of baccalaureate nursing programs. Achievement of these outcomes will enable graduates to practice within complex healthcare systems and assume the roles: provider of care; designer/manager/coordinator of care; and member of a profession. The nine Essentials are: x Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice

o A solid base in liberal education provides the cornerstone for the practice and education of nurses.

x Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety

o Knowledge and skills in leadership, quality improvement, and patient safety are necessary to provide high quality health care.

x Essential III: Scholarship for Evidence Based Practice o Professional nursing practice is grounded in the translation of current

evidence into practice. x Essential IV: Information Management and Application of Patient Care

Technology o Knowledge and skills in information management and patient care technology

are critical in the delivery of quality patient care. x Essential V: Healthcare Policy, Finance, and Regulatory Environments

o Healthcare policies, including financial and regulatory, directly and indirectly influence the nature and functioning of the healthcare system and thereby are important considerations in professional nursing practice.

x Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes

o Communication and collaboration among healthcare professionals are critical to delivering high quality and safe patient care.

x Essential VII: Clinical Prevention and Population Health o Health promotion and disease prevention at the individual and population

level are necessary to improve population health and are important components of baccalaureate generalist nursing practice.

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x Essential VIII: Professionalism and Professional Values o Professionalism and the inherent values of altruism, autonomy, human

dignity, integrity, and social justice are fundamental to nursing. x Essential IX: Baccalaureate Generalist Nursing Practice

o The baccalaureate-graduate nurse is prepared to practice with patients, including individuals, families, groups, communities, and populations across the lifespan and across the continuum of healthcare environments.

o The baccalaureate graduate understands and respects the variations of care, the increased complexity, and the increased use of healthcare resources inherent in caring for patients (AACN, 2008).

INTEGRATIVE LEARNING STRATEGIES

Achievement of outcomes delineated in the Essentials of Baccalaureate Education for Professional Nursing Practice (2008) is enhanced through the intentional use of active, collaborative, and integrative learning strategies. The American Association of Colleges & Universities (AAC&U 2004) defines Integrative Learning Strategies as powerful, active, and collaborative instructional methods that thread general education concepts throughout the major. Integrative learning strategies, as used in this document, expand on this definition and includes the integration of:

x liberal education throughout the nursing curriculum x practice with theory x practice knowledge and theory across essentials x active learning strategies throughout the curriculum x interprofessional learning opportunities; and x learning activities across academic disciplines

The purpose of this document is to provide nursing programs with examples of educational approaches that actively engage the learner and integrate liberal education, nursing science, clinical reasoning, and ethical considerations into both classroom and clinical learning. These examples are provided as a starting point to develop learning activities for the preparation of entry-level professional nurses and may be relevant to more than one essential. The learning strategies include a variety of methods, such as unfolding case studies, simulation, and reflective practice exercises to assist with implementation of a well-integrated curriculum based on the AACN’s Baccalaureate Essentials. By their nature, integrative learning strategies listed in this document may address more than one of the Baccalaureate Essentials. The following integrative learning strategies were developed by the American Association of Colleges of Nursing (AACN) Task Force on the Revision of the Essentials of Baccalaureate Education for Professional Nursing Practice with input from participants at regional meetings held across the Unites States in 2007-2008. These strategies are consistent with the work of the AAC&U (2007) and the Carnegie Foundation’s (In press) ongoing work on education in the professions.

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Examples of Integrative Learning Strategies Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice

x Provide local, national, and international experiences, framed by reflective questions, in a variety of cultures, organizations, and communities.

x Promote activities and projects with students from the arts, humanities, and sciences to address community issues or problems.

x Use collaborative learning projects to build communication and leadership skills.

x Engage in community-based activities to promote ethical reasoning, advocacy, collaboration, and social justice.

x Provide opportunities to reflect on one’s own actions and values to promote ongoing self-assessment and commitment to excellence in practice.

x Provide guided exploration of diverse philosophies, ways of knowing, and intellectual approaches to problem solving.

x Use simulation exercises and case-based scenarios with students from other academic disciplines such as history, religion, business, and engineering.

x Provide direct experiences integrating artistic ways of knowing such as the arts, cinema, poetry, literature, and music to enhance the practice of nursing.

x Provide opportunities to observe and participate in various cultures through study abroad.

x Participate in interprofessional service learning activities such as health promotion and disease prevention projects for diverse populations.

x Use writing intensive assignments to promote reflection, insight, and integration of ideas across disciplines and courses.

Essential II: Basic Organizational and Systems Leadership for Patient Safety and Quality Care

x Provide leadership experiences in a variety of organizations and communities. x Provide opportunities for students to:

o Engage in practice settings to build communication and leadership skills.

o Communicate with recognized leaders to solve healthcare practice problems.

o Develop a leadership or quality improvement project that spans several courses (e.g., review literature about a practice problem in one course, propose a practice change based on an evidence-based model in a second course, and then present the practice change to appropriate stakeholders in a third course).

o Shadow a leader and reflect on the experience. o Engage in quality improvement/patient safety activities to promote an

understanding of the organizational process, unit application, and evaluation process.

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o Participate in quality improvement activities and/or required regulatory reporting systems.

o Participate in interprofessional performance improvement team currently working on implementation/evaluation of national patient safety goals.

o Propose an innovative solution to a system-related patient care problem identified in one’s clinical practice.

o Conduct a mock root cause analysis on a near miss and share results with staff or shared governance council.

o Participate in an actual Root Cause Analysis (RCA) and/or Failure Mode Effects Analysis (FMEA).

o Role-play with nursing and medical students using Situation, Background, Assessment, Recommendation (SBAR) communication

o Attend a professional nursing organization meeting and identify personal development opportunities.

o As students examine various microsystem committees, identify one for more in-depth exploration.

Essential III: Scholarship for Evidence-Based Practice

x Ask students to select a clinical topic, search for evidence, and identify the level of evidence for each sample of evidence.

x Create journal clubs where students critique a primary nursing research article and its relevance to their clinical practice.

x Group students according to a clinical issue of interest, conduct a systematic review, and debate the rigor of selected research studies.

x Use controversial case studies to promote discussion about decision making and the evidence that supports those decisions (e.g., If you dropped the patient's last pill, and each pill costs $35 …would you use it? or if a terminally ill patient asks you if he is dying, would you be truthful?).

x Collaborate with librarians to conduct comprehensive and efficient searches on clinical topics.

x Provide a sample of nursing journals and ask students to identify a research article and determine the type and level of evidence included.

x Assign student peer review of a student colleague’s paper. x Provide opportunities/assignments for student to:

o Identify clinical questions in PICO (Patient problem, Intervention, Compare, Outcome) format and conduct searches for current evidence using the PubMed PICO search feature.

o Examine the evidence for an existing policy or procedure using multiple sources (e.g. Cochrane, AHRQ, CINAHL, PubMed).

o Apply specific criteria to evaluate health information resources for lay and professional use as well as to discuss the ethical implications of commercial sources that target laypersons.

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o Collaborate with clinical partners to identify practice problems, formulate evidence-based conclusions and recommendations, and present findings in poster format to staff and class.

o Apply evidence-based practice models to assess the applicability and feasibility of new findings to practice.

o Cite sources of evidence for planned interventions. o For assigned patients, compare observed practices with published practice

standards. o Link how individual nursing actions are related to recognized nurse

sensitive quality indicators. Essential IV: Information Management and Application of Patient Care Technology

x Provide opportunities/assignments for students to: o Use information and patient care technology to communicate

effectively with members of the healthcare team. o Use clinical evidence and research to base and validate practice

decisions related to information management and patient care technology.

o Participate in quality improvement activities and required regulatory reporting through information systems.

o Employ a range of technologies that support patient care, such as electronic health and medical records, patient monitoring systems, and medication administration systems.

o Use simulation and electronic medical records to access and analyze data relevant to the patient situation.

o Use information technology resources such as Wiki, Second Life simulation, or SkyScape.com to communicate with other healthcare professionals or students in other disciplines regarding a joint project.

o Develop a professional e-portfolio. Essential V: Healthcare Policy, Finance, and Regulatory Environments

x Provide opportunities/assignments for students to: o Observe a state board of nursing hearing and reflect on how the state

practice act protects the welfare and safety of the citizens. o Participate with national or state nursing associations in activities such as

“lobby day”. o Review proposed legislation affecting health care and provide written

comments. o Attend national or state congressional hearings on healthcare issues. o Observe testimony at a state legislative or regulatory hearing on a

healthcare issue focusing on access to care or patient advocacy.

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o Provide written or verbal feedback on the ethical, financial, and social implications of the testimony observed and recommended policy changes.

o Compare the costs of common diagnostic tests, procedures, and medications charged to insurance companies vs. self-pay patients.

o Explore the costs and availability of care options for patients with dementia or a psychiatric/mental health illness in your local community. (What does private health insurance cover? Medicaid? Medicare?).

o Develop a lobbying plan for an identified issue that includes a concise (30 seconds or less) oral synopsis for a decision maker and a one-page policy memo.

o Participate in advocating for change in policy related to a selected healthcare issue at the local, state, or national level.

o As an interprofessional group, role play a legislator, proponent and opponent for a healthcare or professional issue.

o Analyze a hospital bill for one day of care in an acute setting and identify where nursing services are embedded.

o Compare one or more healthcare systems in other countries with the U.S. system, including costs, services provided, and outcomes, (e.g., pre-and postnatal care, role of midwife and other healthcare professionals/workers, insurance coverage, maternity/paternity leave).

o As an interprofessional group, develop a policy (new or revised) to address an issue identified in a practice setting. Delineate processes for getting policy adopted and implemented within that practice setting.

Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes

x Provide opportunities/assignments for students to: o Engage in case study discussions/dialogue with a variety of healthcare and

other professionals. o Participate in interprofessional collaboration (e.g., grand rounds,

community coalition meetings). o Work in interprofessional and intraprofessional teams on course

projects/assignments. o Engage in interprofessional and intraprofessional care in simulation labs. o Develop interprofessional community projects. o Assess group dynamics of an interprofessional or intraprofessional group . o After attending a professional meeting of another healthcare profession,

compare and contrast professional perspectives. o Participate on interprofessional teams at national competitions (e.g.,

Clarion Interprofessional Team Case Competition at the University of Minnesota, National Student Nurses Association).

o Participate in campus-wide student governance and committees. o Organize activities for National Primary Care Week as a student

ambassador.

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Essential VII: Clinical Prevention and Population Health for Optimizing Health

x Provide opportunities/assignments for students to: o Analyze health behavior(s) of self or others using models or theories. o Participate in individually-focused clinical prevention activities such as:

� teaching about and providing immunizations � improving adherence to tuberculosis chemoprophylaxis through

health teaching and directly observed therapies � providing health counseling regarding smoking cessation, stress

management, exercise, and diet � teaching about and encouraging cancer screening � conducting basic environmental exposure history regarding

pesticides � conducting basic genetic health screening and referring high risk

individuals to genetic services � assessing a home environment and health counseling to prevent

falls in older adults � identifying and intervening in elder abuse;

o Use clinical practice guidelines for planning and/or evaluating clinical prevention interventions.

o Participate in community or population-focused assessment. o Participate in development of plans and policies to effectively prepare a

community for disasters or to protect vulnerable populations during disasters.

o Help organizations and communities create healthy environments such as smoke- free workplaces.

o Teach vulnerable populations about avoiding environmental risks. o Collaborate with institutions, such as day care centers or homeless

shelters, to develop and implement policies to minimize transmission of communicable diseases.

o Participate in a community disaster drill. o Develop a policy memo to address a health issue identified in the

community. o Advocate for policy change regarding a health issued identified in the

community. o Initiate an interprofessional going-green campaign to improve

environmental health. Essential VIII: Professionalism and Professional Values

x Provide opportunities/assignments for students to: o Write a letter to the editor or opinion editorial about the role of nursing in

improving health care and submit the letter to a local newspaper for publication.

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o Observe and respond to focused questions about the proceedings of ethical review committees, IRB, nursing practice councils, and state board of nursing meetings and/or hearings.

o Participate in professional or community-based organizations that advocate for quality and access to care.

o Use simulated vignettes that address ethical, legal. and moral patient care situations such as: � provider abandonment of a patient � decision-making about reporting to work in the event of a disaster � reporting sexual assault or abuse � suspected drug use by a colleague � end-of-life decision-making � identification of a spiritual crisis � withdrawal of life support

o Participate in interprofessional service-learning projects such as student visits to secondary schools, school career days, summer health camps, or vulnerable populations in homeless shelters or homes for battered women and children.

o Partner with a nursing school from another country to gain global perspective; use the internet for global experiences.

o Engage in legislative state house visits to articulate professional nursing role/perspective.

o Work with legislative staff at various levels. o Participate in values clarification exercises, using poems, literature, and

video clips that illustrate bias, such as the “See Me Nurse” video on aging (Southern Region Coalition).

o Participate in rounds with chaplains or other spiritual care professionals. o Develop a self-care improvement plan. For example, use a tool such as the

“Circle of Human Potentials” (Dossey & Keegan, 2009) ) to conduct a self-assessment and develop a self-care improvement plan that includes measurable outcomes.

o Conduct a self-assessment in one or more of the following areas: physical, emotional, spiritual, cultural, relationships, communications, and learning style. Based on this assessment, develop an improvement plan that includes measurable outcomes.

o Analyze the media’s portrayal of nurses and other aspects of health care. o Discuss cultural and ethical variables in patient care scenarios using

software, such as The Neighborhood (Gidden, 2007) in interprofessional and intraprofessional learning groups.

o Use reflective writing to discuss student use of moral agency and/or patient advocacy.

o Create a student honor code to be adopted. o Engage with a nurse actively involved in professional nursing practice for

more than 30 years to explore changes within the profession.

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Essential IX: Baccalaureate Generalist Nursing Practice x In a group of students, plan, provide and evaluate nursing care for a patient with

multiple co-morbidities and symptoms in a simulated or patient care environment. x In a group of interprofessional students, provide care that reflects patient preferences

and values in a simulated or patient care environment. x Arrange cultural immersion care giving experiences in settings such as homeless

shelters, migrant clinics, correctional facilities, and corporate health settings. x Provide opportunities/experiences for students to:

o Provide evidence-based, patient-centered end-of-life care to a dying patient and their significant others.

o Interview volunteers with complex problems, such as HIV, psychiatric conditions, tuberculosis, or substance abuse to explore patient preferences and values.

o Provide care to a group of patients that incorporates delegation, supervision, and outcomes evaluation.

o Administer and document administration of medications to groups of patients in a patient care or simulated environment.

o Perform patient assessment and evaluation of a patient’s response to pharmacological agents in a simulated or patient care environment.

o Use unfolding case study analysis to correlate a patient’s medical condition and pathophysiology and design appropriate therapeutic interventions.

o Use a constructed genetic pedigree from collected family history information to identify a risk profile and develop a plan of care, including patient education and referral.

o Use simulation, case studies and patient assignments to make decisions about the organization, prioritization, and appropriate delegation of care.

o Consult with other professionals to improve transitions of elderly patients across care settings.

o Evaluate patient education materials for cultural and linguistic appropriateness.

o Elicit a spiritual history and integrate a patient’s spirituality into the care plan.

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OPPORTUNITIES FOR PROGRAM ENHANCEMENT

The following indicators of quality serve to guide baccalaureate nursing programs as they strive for excellence. These suggestions are intended to go beyond required program standards and to build upon the program components identified in AACN’s The Essentials of Baccalaureate Education for Professional Nursing Practice (2008). In the pursuit of continuous improvement, programs may use these indicators of quality to develop action plans appropriate to their mission, philosophy, and core values. This culture of continuous quality improvement fosters inquiry and creativity. While all accredited programs engage in quality improvement processes, the indicators of quality discussed in this document identify elements which can further enhance the quality of the program. These indicators were not developed to be used as accreditation standards. This document identifies elements believed to increase excellence in baccalaureate nursing programs and offers strategies that are most promising for moving programs forward in their quest for excellence. Academic Infrastructure Infrastructure refers to the platform of support provided by an institution to promote the success of its academic programs. Attention to best practices in regards to infrastructure can facilitate a program’s progress to a higher level of excellence. A strong academic infrastructure provides a variety of learning opportunities for students to achieve the Baccalaureate Essentials. Baccalaureate nursing programs moving toward excellence invest in sufficient financial, personnel, instructional, and academic resources as well as facilities to incorporate successful practices into their programs. In addition, programs allocate resources to provide opportunities beyond those necessary for successful program completion. Best practices include providing opportunities for students to attain maximum potential for a successful career trajectory and professional successes, in addition to fostering innovation, creativity, and new ways of thinking and doing. The academic infrastructure reflects the unique qualities of the program and includes exemplary student life and academic support services such as honors programs, opportunities for student involvement in faculty research, internships, student organizations, remediation, and other enhancement programs. Quality programs support enrichment opportunities such as international study, service learning, and career planning. Students have local or international experiences with diverse populations, second-language immersion opportunities, or other experiences indicating involvement in cultural or global issues. Student access to resources, such as scholarships and support for scholarly projects or activities, is an additional indicator of quality. Resources and opportunities are developed to support student goals and the needs of a diverse student population. The presence of institutional resources for research, development, business operations, public relations, marketing, and human resources reflects quality in baccalaureate nursing programs. For example, exceptional programs develop processes to expand and sustain resources in the areas of information technology, library holdings, clinical laboratories and equipment, and space provided for student learning and faculty scholarship.

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Institutional support for faculty development is evidenced by written policies and budget allocations. Benchmarks for faculty development are established and evaluated for quality improvement initiatives. Best practices may include strategies to attract faculty with outstanding academic preparation and experience to enhance the program’s unique mission or to serve a specific community of interest. Academic Environment Principled leadership is an important indicator of quality. This leadership supports and rewards faculty collaboration for teaching, scholarship, and service. Effective leaders create an environment that encourages faculty and staff to engage in reflective thinking and critical analysis of professional contributions and program outcomes. Strategic planning, resource allocation, and staffing to achieve program goals are guided by effective leadership to produce supportive academic environments. Excellent academic programs forge partnerships with practice organizations, such as community agencies and healthcare systems that are mutually beneficial. Examples of mutual benefits include collaborative research and practice initiatives, design of educational experiences and curriculum, as well as the sharing of staff and faculty. The partnership of education and practice, through a process of continuous evaluation, fosters mutual accountability. Quality partnerships are successful when they clarify goals, objectives, and responsibilities, as well as work toward the success of all stakeholders (Gilliss & Fuchs, 2007). Strong partnerships provide opportunities for students to expand and improve their practice and create an environment where teaching reflects best nursing practices. Partners share a commitment to excellence in nursing practice and education. Academic environments, while focused on the climate for student learning, support faculty efforts to implement best practices. Best practices promote explicit opportunities for the integration of liberal education and learning throughout the nursing curriculum. Student application of principles of liberal learning as evidenced in nursing course syllabi and course materials as well as teaching-learning activities are selected to match student abilities and previous academic preparation. Students can articulate the value of their liberal education courses to their preparation as professional nurses as well as educated citizens. Students express accountability for their own learning throughout the academic experience and beyond. In addition, students are actively engaged in learning and are encouraged to question and seek answers through a variety of inquiry methods. A spirit of inquiry and the excitement of discovery permeate such environments. Academic environments that best support student success create high expectations for student learning. Integrative learning strategies focus on the spirit of inquiry and the development of a community of scholars. Students and faculty in quality programs engage in synthesizing experiences in collaborative and service learning projects as well as interdisciplinary work across departments. Best practices include the use of multiple teaching strategies and methods of evaluation that provide ongoing feedback to enhance student outcomes. Classroom experiences are relevant to students’ lives, aspirations, and experiences. In addition, best practices produce retention, graduation, national licensure

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examination pass rates, and student successes that reflect the program’s admission standards and academic support services. Best practices regarding academic environments include support for faculty practice, teaching, scholarship, and service roles as appropriate to the program’s mission. This commitment is evident through systems that support a broad conceptualization of scholarship and institutional reward systems for faculty scholarship. Congruence between the parent organization’s definitions of these roles is paramount and the reward system for scholarly activity is evident. Best practices include a plan for the dissemination of faculty scholarly efforts to assure that outcomes have an impact beyond the school or institution. Indicators of best practices related to scholarship may include extramural grants in support of practice innovations; peer-reviewed publications and presentations; practice- oriented grant review activities; editorial review activities; state, regional, national, and international professional activities related to one’s pract

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