Graduate Curricula in Nursing NURS 212 October 18

Graduate Curricula in Nursing NURS 212 October 18, 2006 Phyllis M. Connolly Ph. D, APRN-BC, CNS Professor, School of Nursing

Nursing’s responsibility is awesome—in patient care and also in creating a new society (Nyberg, 1998, p. 209)

“To be active participants in shaping the health care system, nurses must learn new skills” Alderman (2001, p. 50)

Questions to Consider n n What role does history play in graduate nursing education? What are the major differences between the undergraduate, graduate and doctoral curricula? What are the significant internal and external factors affecting the development of graduate nursing programs? What are some outcome measures of graduate nursing education?

Critical Elements Affecting Graduate Nursing Education n History n n n n Role of women in society Societal needs War Military Industrialization Technology Immigration Legislation n n Nurse Practice Acts Medicare n n n National Policy Third-party reimbursement Inter and Intra Professional Organization n n Standards Certification

Initial Graduate Education n n 1920 s Case Western Reserve 1923 Yale University (Gold Mark Report & Rockefeller Foundation) n n n Education Administration World War II 1945 to 1970 s n n Nurse educators Administrators Clinical nurse specialist Nurse practitioners

History of Advanced Practice Nurses: Nurse Anesthetist n n n Nurse anesthesia mid 1800 s Today CRNA Sister Mary Bernard, St. Vincent’s Hospital in Erie, PA 1877; formed a network of hospitals “Mayo Clinic” Alice Magaw by 1906 over 14, 000 surgical cases—no deaths. Specialized field require education and moved away from nursing administrative structures. Greatly influenced by American military and major wars 1945 AANA initiated certification program 1999 28, 000 CRNA in US 1973 University of Hawaii, first master’s degree program, nurse anesthetist

Clinical Nurse Specialist n n Responding to improving quality of nursing care Directors of Graduate programs responded 1954 1 st CNS, Dr. Peplau 1954, Rutgers Influenced by National Mental Health Act 1946, psychiatric nursing a core discipline n Funding

Nurse Practitioners n 1971 Idaho 1 st state to authorize the expanded role controlled by Board of Nursing and Medicine n n Controversy over prescriptive authority Loretta Ford, 1965, Colorado 1 st Pediatric NP program, certificate; 4 months intensive then 20 months training and practice 1990 over 135 masters programs; 40 certificate 1998 over 750 masters and 12

Nursing Education Baccalaureate Doctorate BSN Master’s Doctorate Research Read & Evaluate Evidence based; evaluate use & do Develop theories; models; tools; conduct Programs Generic; MSN; MS/MBA Ph. D; Ed. D; accelerated; RN Certifications DNSc; DNP to BSN Accreditation BRN; CCNE; NLN BRN; CCNE; WASC NLN; NONPF; WASC

Model of Master’s Nursing Curriculum Graduate Nursing Core Administration APN Clinical Core Community Health Educator* CNM Specialty Curricula CRNA Primary Care NP NP CNS School Nurse CNS* Acute NP * Not part of AACN Essentials Model P. M. Connolly 2006

Number of Advanced Practice Nurses in the US March 1996 % TITLE TOTAL NUMBER CURRENTLY IN NURSING % NATIONALLY CERTIFIED CRNAs 30, 386 86. 7 84. 4 CNMs 6, 534 81. 7 87. 9 CNSs: Psy Peplau Rutgers 1954 53, 799 90. 5 23. 6 NPs Ford, Colorado 1965 63, 191 88. 2 63. 5 CNS/NPs 7, 802 100 70. 9 NCMs NO DATA Hamric, Spross, & Hanson, 2000, p. 7

1980 s - 2006 n n n Case Manager School Nurse Parish Nurse Informatics Clinical Nurse Leader

Core Curriculum Research; evidence-based outcomes; health policy; nursing & Health related theory; organizational/leadership theory; environmental health; ethical & legal issues; multicultural care; economics & business theory; community partnerships; managed care; health care delivery systems

Curriculum Core Courses: 14 Units, SJSU n n NURS 200 Health Care Systems, 3 n Units NURS 202 Theoretical Foundations, 2 units NURS 204 Diverse Populations and Health Care, 3 units NURS 295 Research Design, 3 units NURS 297 Seminar Project or Thesis, 1 unit NURS 297 Project or Thesis, 2 units

Advanced Practice Curriculum Advanced health assessment n Pharmacology n Physiology n Advanced patho/physiology Core Specialty Practice n n n n Anesthesia Nurse Practitioner Clinical Nurse Specialist Nurse Midwife School Nurse Educator Nurse Administrator

Family Nurse Practitioner 30 Units n n NURS 248 Adv. Health Asses, 3 units* NURS 250, FNP Theory I, 2 units* NURS 252, FNP Theory II, 2 units* NURS 253, FNP Practicum I, 5 units* n n n *Special Session Fees NURS 254, FNP Practicum II, 5 units* NURS 256, FNP Practicum III, 5 units* NURS 258, FNP Professional Issues, 2 units* NURS 259 Advanced Pharmacology, 3 units; Dominquez Hills, online NURS 260 Advanced patho/physiology, Dominquez Hills, online

School Nurse Clinical Specialist & Credential n n NURS 206, 3 units, Advance Health Assessment NURS 270, 3 units, School Nursing Pathophysiology & Pharmacology n n n NURS 272, 5 units, School Nursing I: Clinical Nurse Specialist (CNS) NURS 274, 5 units, School Nursing II: CNS 2 Education supporting courses, 3 units each

Nurse Administrator n n n NURS 246 Modern Organizations & Health Care, 3 units NURS 236 A Nursing Adm. Theories, & Practicum I, 3 units NURS 236 B, Nursing Adm. Theories, & Practicum, II, 4 units n n NURS 266 Health Care Informatics BUS 220 Accounting Principles, 3 units BUS 285 Total Quality Management, 3 units BUS 286 Project Management, 3 units

Special Moore Foundation: MS & Post-MS Certificate n n n n Educator Track 16 months; Cohort II Fall 06 completion December 2007 Funded with forgivable loans All Special Session fees Stipends available ($20, 000) Must attend Teacher/Scholar monthly seminars MS must agree to teach full-time for 3 yrs. in any RN program in Alameda, Marin, Santa Clara, San Francisco or San Mateo Counties Post MS certificate agree to teach full-time for 1 yr in any RN program in 5 Counties

Nurse Educator Option 22 Units n n NURS 212 Curriculum Design, 3 units NURS 214 Nursing Education Theory & Practicum I, 5 units (240 hrs clinical) NURS 216 Nursing Education Theory & Practicum II, 5 units (240 hrs. clinical) NURS 208 Special Topics (20 clinical hrs. ) or EDIT 272, Distance Education n n NURS 266 Health Care Informatics on-line course, 3 units* EDIT 186 Instructional Media/ 3 units; blended online and in person

IOM Rules for Redesign (2001) n n n Care is based on continuous healing relationships Care is customized according to patient needs & values The patient is the source of control Knowledge is shared & information flows freely Decision making is evidence-based

AACN: Role New Clinical Nurse Leader 2005 n n Leadership in care of sick across all environments Design and provision of health promotion and risk reduction services for diverse populations Provision of evidence-based practice Population-based health care to individuals, clinical populations & communities

AACN: Role New Clinical Nurse Leader n n Leadership in care of sick across all environments Design and provision of health promotion and risk reduction services for diverse populations Provision of evidence-based practice Population-based health care to individuals, clinical populations & communities

Driving Forces Program Evaluation n n Commission on collegiate Nursing Education (CCNE) NONPF BRN WASC University Review Policy

WASC n n n n One of 6 regional accrediting associations Voluntary, non-governmental Purpose to foster education excellence Institution must define quality & excellence File annual report Visit with self-study every 5 years Nine standards

Theoretical Frameworks for Evaluation n Total Quality Management Continuous Improvement Donabedian’s Model n n n Structure Process Outcome

B RS NN SCHOOL OF NURSING Total Program Evaluation Model o. S BC SH NO SCHOOL’S MISSION & PROGRAM EVAULATION PLAN O FL N PN U R S E CURRICULUM Curriculum UNIVERSITY MISSION Employers’ Needs Society’s Values PROGRAM FEEDBACK GENERAL PUBLIC FEEDBACK OF EXPLICIT OBJECTIVES, MEANS, AND COSTS Program Outcomes BSN MS RN to BSN FNP SNCred ALTERNATIVE PROGRAMS LOCATIONS, CONTROLS, AND MONEY Program Evaluation and Research Committee 10/97 Rev/ 4/99 Approved 2/12/01

CCNE 2001 Standards n n I. Program Quality: Mission/governance II. Program Quality: Institutional Commitment & Resources IIII. Program Quality: Curriculum & Teaching-Learning Practices IV. Program Effectiveness, Student Performance & Faculty Accomplishments

Process n Semester Curriculum Meetings n n Course Reviews Curriculum Committee n Curriculum review n Task n n Force Reviews end of semester Standing Committees Faculty Meetings

School of Nursing Program Evaluation & Feedback System: On Going Systematic Evaluation Full Faculty Meet Monthly Curriculum Coordinating Committee Meet Monthly Represents All Semesters Semester Level Curriculum Committees Meet Monthly Represents all Faculty Teaching in Semester Continuous Improvement Task Forces Meet End Each Semester Program Evaluation & Research Committee Meet Monthly Report: NCLEX, BSN Exam, Grad Rates, Employment Patterns, Demographics, Course Satisfaction Continuous Improvement Task Forces Gerontology Adult; Community Psych/Mental Health Graduate Semesters 3 - 8 Bridge Meet Monthly Theory Process Skills Practicum BRN Content Experts Specialization Experts Across the Curriculum Student Representatives Recommendations To Curriculum Coordinating Committee Review & Make Recommendations Based on Results of Standardized tests

Masters SON Outcomes n n “Implement care management, including but not limited to case management, resource management, advocacy, and outcome evaluation; ” Apply critical thinking and ethical decision making including the use of the nursing and research processes; ”

Program Outcomes Incorporating systems theory concepts, ANA Social Policy Statement (1995), relevant ANA Standards of Care, AACN Essentials for Master’s Education for Advanced Practice Nursing (1996), National Organization of Nurse Practitioner Faculties (NONPF); and the California Board of Nursing, the master’s nursing graduate will: n n apply critical thinking and ethical decision-making including the use of the nursing and research processes; provide theory and research-based culturally competent, safe therapeutic nursing interventions for clients in advanced nursing practice; employ advanced interpersonal skills in professional relationships with clients, families/caregivers, and multidisciplinary health care team members; support health promotion and disease prevention activities in developing and monitoring holistic plans of care for well and at-risk clients, considering access, quality and cost;

Program Outcomes Cont. n n n demonstrate the collaborative and leadership skills required in advanced nursing practice within a multidisciplinary and multicultural (community) health care context; plan, implement, and evaluate advanced nursing practice that promotes and preserves health and healthy lifestyles of individual clients and aggregates; plan, implement, and evaluate advanced therapeutic nursing practice in a rapidly changing, multicultural health care environment; implement care management, including but not limited to case management, resource management, advocacy, and outcome evaluation; employ information technology in advanced nursing practice to evaluate and improve heath care delivery and outcomes; actualize the advanced nursing practice role by incorporating professional standards, ethical guidelines, legal mandates, and professional activities.

Graduate Publications n n Beddoe, A. , & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43, 305 -312. Litarowsky, J. , Murphy, S. , & Canham, D. (2004). Evaluation of an anaphylaxis training program for unlicensed assistive personnel. Journal of School Nursing, 20(4), 57 -62. Moody, P. Gonzales, I. , & Cureton Young, V. (2004). The effect of body position and mattress type on interface pressure in quadriplegic adults: A pilot study. Dermatology Nursing, 16(6), 507 – 512. Ngoh Toche, C. , Lewis Daniels, I. & Connolly, P. M. (2005). Outcomes of inpatient geropsychiatric treatment. Journal of Gerontological Nursing, 31(4), 12 -18.

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