N523 Gap Analysis

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WSU COLLEGE OF NURSING

SENIOR 1: PRE-LICENSURE CURRICULAR NEEDS ASSESSMENT AND GAPS ANALYSIS SUMMARY

NURS523: EDUCATION ISSUES AND CURRICULUM ANALYSIS

TEAM SPLENDID SCHOLARS:

Margaret Baldridge

Ruth Bryant Elaine Clement

Ira Kantrowitz-Gordon Mariana Sheldon Marian Wilson

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March 4, 2012 WSU College of Nursing

Senior 1: Pre-licensure Curricular Needs Assessment and Gaps Analysis Summary

NURS523: Education Issues and Curriculum Analysis

Team Splendid Scholars

Table of Contents

Introduction ..........................................................................................................................................................................................................................2

Evaluation of Senior 1 Nursing Courses based upon CON Program Outcomes .................................................................................................................4

Evaluation of Senior 1 Nursing Courses based upon AACN Baccalaureate Essentials ....................................................................................................15

Evaluation of Senior 1 Nursing Courses based upon WSU Big 7 Goals...........................................................................................................................24

Evaluation of Senior 1 Nursing Courses based upon Nursing Commission Requirements ..............................................................................................28

Evaluation of Senior 1 Nursing Courses to NCLEX .........................................................................................................................................................32

Evaluation of Senior 1 Nursing Courses upon QSEN .......................................................................................................................................................39

Evaluative summary of gaps and recommendations based upon WSU Big 7, Nursing Commission, NCLEX, CON, QSEN and AACN Baccalaureate Essentials criteria…...……………………………………………………………………………………………………44

Conclusion………………………………………………………………………………………………………………………………………….……56

List of Works Cited………………………………………………………………………………………………………………………………………58

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WSU College of Nursing




Introduction

The student members of “Team Splendid Scholars” conducted a review of an assigned group of courses in the school of Nursing at Washington State

University to determine if there were any gaps between the curriculum intent and the criteria used by external evaluating agencies. This type of

review requires having adequate knowledge of the subject matter and a sufficient understanding of the individual course content to make a decision

(Whittington, 2004). Decisions about curriculum analysis depend upon a clear understanding of the standards against which the curriculum is being

judged, and the criteria used to determine if the standards are being attained (Iwasiw, 2009). For the purposes of this particular review, the criteria

used for evaluating the nursing courses included:

WSU Big 7 (Office of Assessment of Teaching and Learning, 2011)

Nursing Commission (Commission on Collegiate Nursing, 2009)

NCLEX (National Council of State Boards of Nursing, 2009)

CON Program Outcomes

QSEN (QSEN Phase III Steering Committee, 2012)

AACN Baccalaureate Essentials (American Association of Colleges of Nursing, 2008)

The objective of this review was to provide a basis for communicating whether any material modifications should be made to any of the courses to

conform to these specified criteria. This report does not conclude any representation as to the quality nor student outcomes of the WSU nursing

curriculum or program. We specifically reviewed the pre-licensure curricular needs assessment and gaps analysis submitted by the faculty for the

following courses in the WSU College of Nursing:

N408 Professional Development: III Leadership and Management

N412 Family and Community as a Context of Care

N414 Child and Family Health Theory

N415 Children and Families as the Focus of Nursing Care

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N416 Childbearing Health of the Family

N417 Nursing Care of Childbearing Families

These courses are all from the first semester of the senior year of the baccalaureate nursing program. As a result, courses that form part of a series,

for example, the Leadership and Management courses, were each reviewed individually, separate and apart from each other. In the future, it may be

preferable to review course series as a group. This is because every course does not need to meet every criterion. The curriculum needs to be

evaluated as a whole.

Based upon our review, we present the following recommendations. In the first section, courses are evaluated based upon each group of standards in

a tabular format followed by a list of recommendations. This section is followed by an evaluative summary of gaps and a list of recommendations

for each course based upon all of the standards. We conclude this project with some closing statements about the WSU nursing curriculum overall.

This compilation and review was limited to the form prescribed by WSU and presented in accordance with the requirements of the academic

assignment, which differ substantially from generally accepted auditing standards, the objective of which is the expression of an opinion regarding

the curriculum taken as a whole.

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Evaluation of Senior 1 Nursing Courses based upon CON Program Outcomes

UCC is conducting a 4 year review of the pre-licensure nursing curriculum. This year, the Committee is conducting a needs assessment and gap

analysis of our curriculum when compared to college, university, regulatory, professional and community outcome expectations. Each course will be

evaluated utilizing the ‘Pre-licensure curricular needs assessment and gaps analysis forms 1 and 2.’ Gap Forms 1 & 2 completed by faculty teaching

each Senior1 course will be made available to you. Please complete this form as a summary of the individual course forms provided to you. Provide

a summary of gaps based for each of the factors impacting curricular development listed below.

CON PROGRAM OUTCOMES:

N408 N412 N414 N415 N416 N417

Competence in Provision

of Care

1. Provide competent nursing

care to individuals, families, groups and

communities through promotion, maintenance and

restoration of health; prevention of illness,

and physical, emotional, and spiritual support

throughout life the span.

I,R

R

R, I

Gap: Need

more time for class

discussion and case studies with

more individual

written work. Difficult to do small

groups over AMS, and

workload of correcting

R

Gap:

Discrepancy among clinical

groups in their opportunities for equal

experiences for the students

(Pediatric opportunities vary from site to

site and community to

community.

M

Gap: Lack

of practical exposure to

diverse groups due to

population encountering

and student population.

M Gaps:

Consider woman’s

health issues including menopause.

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case studies is huge.

The biggest strength of this course is the

ability to provide a

variety of experiences for students.

2. Formulate nursing

practice decisions using evolving

knowledge and research from nursing science, the

biological and behavioral

sciences, and the humanities.

I,R

N/A R

Gap: Need more active

use of EBP by students.

R

R

Gap: Access to

new knowledge curtailed as

budget cuts in library

have begun to be a challenge in

terms of obtaining

some articles.

R

3. Use developmentally

appropriate teaching- learning

principles to assist clients to achieve their health goals

and to assist colleagues to

improve the quality of their nursing care.

I

R

R

R

Gap:

Challenge is that students’

prerequisite development courses vary

considerably so everyone comes

with a different base knowledge in human

development.

R

Gap: More

likely to see in clinical

portion -or leadership for assisting

colleagues.

R Gap:

Consider specific

teaching project.

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Professional

Values

1. Provide

compassionate, ethical care to individuals of

diverse cultures, values, beliefs, and

lifestyles.

I,R Gap: Faculty

report a need to invite more of

the CON affiliate community

nurse leaders.

R

R

Gap: Faculty

report a possible gap

may be the lack of evaluation of

competencies in this

category. Faculty report there

is no opportunity

for actual observation or practice,

but extra credit

assignment often brings these out.

R

Gap: Lack of

consistency of content among

various clinical groups, as often topics come up

as a result of the experiences they

have in clinical.

R

R

2. Demonstrate the

values central to nursing practice

including: altruism, autonomy, human dignity, integrity,

and social justice.

I,R

R

R

Gap: Faculty

report there is a lack of direct

practice experience in

advocacy for underserved or vulnerable

populations.

R

R

.

Not specifically

addressed.

I,R R R R R

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3. Protect the rights of people to receive optimum care and

make informed decisions affecting

their health welfare.

Gap: Faculty report difficultly

to get students freely talking in

large lecture classes of 125-135 students.

Not specifically addressed.

Role

Development

1. Uphold the

standards and values of the profession

including accepting responsibility for learning and

personal growth.

I,R

R

R

R

R

R

Gap:

Faculty ask that consideration

be given to more

independent opportunities for role

exploration in the

childbearing family area.

2. Interpret professional nursing

using perspectives gained from past,

present and future trends in nursing and society.

I,R

N/A

N/A

N/A

Not

addressed.

Not

addressed.

3. Advocate for responsible, humane

health care policies.

I,R

I

R

Gap: Faculty note possible

R

Not

addressed.

Not

addressed.

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gap may be this standard is difficult to

measure.

4. Partner with clients, families,

communities and interdisciplinary health care teams to

design and provide quality health care.

I

Gap: Faculty report on inconsistency in

reception of topic: “Politics

is sometimes a hot button with some cold and

boring button for others.”

N/A R

Gap:

Standard could be met

by having more

opportunity for other disciplines to

interact with students.

R

Gap:

Inconsistent opportunities for

all students to experience

much interdisciplinary interactions.

Not

addressed.

Not

addressed.

5. Participate in

revision of health care policy and practice within a

rapidly changing global environment.

I

N/A N/A

Gap: Lack of

opportunity to participate

in policy revision.

N/A

Not addressed.

Not addressed.

Designer,

Manager, Coordinator of Care

1. Demonstrate

leadership skills and knowledge of the management process

in designing, managing and

coordinating care.

I,R

N/A N/A R

Not addressed.

R

Gap: Consider formal

leadership training

activity or seminar.

2. Use evolving information

technology to

I

N/A R

R

Gap: Clinical

Not

addressed.

Not

addressed.

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Summary of Gap Analysis and Recommendations:


N408 Professional Development III: Leadership & Management

Overall, this series of four courses in Leadership & Management should be updated to reflect the recommendations from the Institute of Medicine’s

The Future of Nursing (RWJ/IOM, 2011) and recent changes in the healthcare industry, such as “Pay-for-Performance” (U.S. Department of Health

& Human Services, 2006). Important topics such as quality improvement, cost-benefit analyses, employee hiring/firing, staff development, and

principles of nursing workload need to be incorporated (American Nurses Association, 2008). We refer faculty to the excellent discussion on pages

251-256, “Skills for the Managed Care Environment: Leadership and Management” in Nursing Education in the Clinical Setting (Emerson, 2007).

The following is a list of the faculty- identified gaps grouped by course with the associated criteria followed by a recommendation:

monitor and improve the health care of clients.

experiences for students vary from agency to

agency so there is a disparity of

IT experience when on site.

3. Demonstrate

knowledge of fiscal

dimensions within a

variety of current

and evolving health

care systems.

I,R

Gap: Faculty report: “It is

difficult in a 3 hour class of over 130 young

adult learners to capture their

attention and interest. Several teaching tools

are used, i.e. YouTube, PPT,

group exercises, guest speakers and websites.”

N/A

N/A

N/A

Not

addressed.

Gap:

Consider

fiscal presentation

in post-conference to meet the

variety of current

evolving health care systems.

Consider discussion

board to meet this objective.

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N408 Gap: Faculty report a need to invite more of the CON affiliate community nurse leaders.

Criteria: Provide compassionate, ethical care to individuals of diverse cultures, values, beliefs, and lifestyles.

Recommendation: Invitations could be extended to CON-affiliated nurses who are leaders of healthcare organizations that specifically provide care

to people of diverse cultures, values, beliefs, and lifestyles in the community.

N408 Gap: Faculty report difficultly to get students freely talking in large lecture classes of 125-135 students. Criteria: Protect the rights of people to receive optimum care and make informed decisions affecting their health welfare. Recommendation: Discussion of such a sensitive topic might be more effective if the students are divided into small groups for case study reviews

and role-playing. Classroom Response Systems (“clickers”) might also be useful to aggregate data from such a large group: “Faculty can pose case studies or clinical problems and ask students for their opinions. Differences in answers can be discussed (O'Neil, 2009, p. 172).

N408 Gap: Faculty report on inconsistency in reception of topic: “Politics is sometimes a hot button with some cold and boring button for others.” Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care

Recommendation: Specific case studies that describe and report on the sometimes dramatic consequences of political decisions on healthcare could be reviewed by students in an online discussion board as part of a hybrid learning environment. Students could also submit reflections online.

N408 Gap: Faculty report: “It is difficult in a 3 hour class of over 130 young adult learners to capture their attention and interest. Several teaching tools are used, i.e. YouTube, PPT, group exercises, guest speakers and websites.”

Criteria: Demonstrate knowledge of fiscal dimensions within a variety of current and evolving health care systems. Recommendation: Fiscal responsibility is a vitally important topic. After graduation, baccalaureate-prepared nurses are often required to be “in

charge”. Those RN’s who do not manage within the constraints of the budget can lose their job. As a class project, different student groups could be assigned to an area of responsibility within a variety of health care systems. Real life scenarios that impact the budget could be presented, and the students would have to problem-solve based upon their knowledge of fiscal dimensions. Examples could include community health clinics, or an

inpatient medical/surgical unit. “A student who expects the world to correspond with the ideal will inevitably be disappointed. If students are able to work only under ideal circumstances, they have been sadly unprepared for reality” (Emerson, 2007, p. 252).

N414 Child & Family Health: Theory N414 Gap: Faculty report a need for more time for class discussion and case studies with more individual written work. Difficult to do small groups

over AMS, and workload of correcting case studies is huge. Criteria: Provide competent nursing care to individuals, families, groups and communities through promotion, maintenance and restoration of health;

prevention of illness, and physical, emotional, and spiritual support throughout life the span. Recommendation: Students can review the case study and formulate responses online prior to class. During class, faculty can pose a question and ask for responses using a Classroom Response System (“clickers”). This information provides faculty with an assessment of understanding the

material and with discussion material. If the students understand the material, the faculty can move to the next topic. If students do not, the faculty can ask students to confer and respond a second time. Discussions can be based on student answers (O'Neil, 2009, p. 172).

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N414 Gap: Faculty report “More active use of EBP by students would be beneficial”.

Criteria: Formulate nursing practice decisions using evolving knowledge and research from nursing science, the biological and behavioral sciences, and the humanities. Recommendation: “It is incumbent upon nurse educators to provide the theoretical foundations for evidence-based practice. To accomplish this,

nurse educators must refurbish curricula to incorporate both the pertinent new and expanded theory in the classroom and relevant practice in the most applicable clinical settings” (Emerson, 2007, p. 252). Therefore, it is recommended that case studies be presented that would require the

students to research evidence-based practice. For example, what would be best practice for management of a child with recurrent episodes of asthma, or uncontrolled diabetes? See above recommendation for evaluation of learning.

N414 Gap: Faculty report a possible gap may be the lack of evaluation of competencies in this category. Faculty report there is no opportunity for

actual observation or practice, but extra credit assignment often brings these out.


Recommendation: This would, in fact, be difficult to measure during a theory class. However, “One single learning environment cannot encompass

all of the knowledge and skills opportunities, but the clinical education experiences of the curriculum taken as a whole should” (Emerson, 2007, p.

254). A self-assessment tool may also be beneficial. “Self-assessment is critical to the process: It is the students, not the instructors, who are the

ultimate arbitrators of the learning experience. The learning environment is one of mutual respect, collaboration, cooperation, and support”

(Candela, 2006).

N414 Gap: Faculty report there is a lack of direct practice experience in advocacy for underserved or vulnerable populations.

Criteria: Demonstrate the values central to nursing practice including: altruism, autonomy, human dignity, integrity, and social justice. Recommendation: Same as above, “One single learning environment cannot encompass all of the knowledge and skills opportunities, but the

clinical education experiences of the curriculum taken as a whole should” (Emerson, 2007, p. 254). In class role-playing and case study exercises

could also be evaluated to bring out any possible problem areas.

N414 Possible Gap: Faculty note a possible gap may be that this standard is difficult to measure. Criteria: Advocate for responsible, humane health care policies.

Recommendation: Self-assessment is critical to the process. It is the students, not the instructors, who are the ultimate arbitrators of the learning

experience. The learning environment is one of mutual respect, collaboration, cooperation, and support (Candela, 2006). However, also recall that:

Nurses are already committed to delivering high-quality care under current regulatory, business, and organizational conditions. But the power to

change those conditions to deliver better care does not rest primarily with nurses, regardless of how ably led or educated they are; it also lies with

governments, businesses, health care institutions, professional organizations and other health professionals, and the insurance industry (RWJ/IOM,

2011).

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N414 Possible Gap: Faculty report “More time for other disciplines to interact with students in classroom format would be great-however they do

have that opportunity in their associated clinical course.” Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care. More interdisciplinary interactions may be provided by increasing on campus interdisciplinary educational opportunities. In class communication,

conflict resolution, and role-playing skills could also be utilized. Students could also be involved in developing interdisciplinary clinical pathways and quality improvement activities.

N414 Gap: Faculty report a lack of opportunity to actually participate in policy revision. Criteria: Participate in revision of health care policy and practice within a rapidly changing global environment.

Recommendation: It may not be realistic for students to actually participate in policy revision, however, students could be engaged in class discussions about this topic.

N415 Children & Families as the Focus of Nursing Care

N415 Gap: Discrepancy among clinical groups in their opportunities for equal experiences for the students (Pediatric opportunities vary from site to

site and community to community). Criteria: Provide competent nursing care to individuals, families, groups and communities through promotion, maintenance and restoration of health;

prevention of illness, and physical, emotional, and spiritual support throughout life the span. Recommendation: This is not specifically a curricula-related issue. It is a challenge faced by many schools of nursing due to a shortage of available clinical sites. Some schools have made attempts for students to identify their preference of clinical site based upon their long term professional

goals. For example, a student interested in pursuing a career in community health nursing may indicate a preference for an outpatient setting.

N415 Gap: Challenge is that students’ prerequisite development courses vary considerably so everyone comes with a different base knowledge in human development. Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to

improve the quality of their nursing care. Recommendation: Encourage SON to review course sequencing and to mandate appropriate course prerequisites.

N415 Gap: Lack of consistency of content among various clinical groups, as often topics come up as a result of the experiences they have in clinical.


Recommendations: Not every clinical learning opportunity will be available to every student, but concepts related to this criterion should be

addressed during group discussions.

N415 Gap: Inconsistent opportunities for all students to experience much interdisciplinary interactions. Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care.

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Recommendation: Again, since clinical learning experiences are variable, more interdisciplinary interactions may be provided by increasing on campus interdisciplinary educational opportunities. In class communication, conflict resolution, and role-playing skills could also be utilized.

N415 Gap: Faculty report clinical experiences for students vary from agency to agency so there is a disparity of IT experience when on site. Criteria: Use evolving information technology to monitor and improve the health care of clients.

Recommendation: If the school can provide the student with basic technology skills, on-the-job training will provide the specific skills needed once hired by an agency.


N416 Gap: Lack of practical exposure to diverse groups due to population encountering and student population.

Criteria: Provide competent nursing care to individuals, families, groups and communities through promotion, maintenance and restoration of health; prevention of illness, and physical, emotional, and spiritual support throughout life the span.

Recommendation: “One single learning environment cannot encompass all of the knowledge and skills opportunities, but the clinical education experiences of the curriculum taken as a whole should” (Emerson, 2007, p. 254).

N416 Gap: Access to new knowledge is curtailed as budget cuts in library have begun to be a challenge in terms of obtaining some articles. Criteria: Formulate nursing practice decisions using evolving knowledge and research from nursing science, the biological and behavioral sciences,

and the humanities. Recommendation: This is not specifically a curricula-related issue. It is more of an administrative challenge faced by many schools of nursing due to a shortage of resources. In the interim, there may be a need to revert to alternative methods to obtain articles until the problem is resolved. This is an

area in which Dr. Doutrich is particularly skilled.

N416 Gap: Faculty report “More likely to see in clinical portion – or leadership for assisting colleagues.” Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to improve the quality of their nursing care.

Recommendation: Assure that appropriate patient education teaching principles are incorporated into the course so that students are prepared to help clients achieve their health goals and assist colleagues to improve the quality of their nursing care when they are in the clinical setting.

N417 Nursing Care of Childbearing Families

N417 Gap: Consider woman’s health issues including menopause.


Recommendation: This would be an appropriate consideration. N417 Gap: Consider specific teaching project.

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Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to improve the quality of their nursing care.

Recommendation: There are already many effective evaluation strategies already in use for this course, N417 Gap: Faculty ask that consideration be given to more independent opportunities for role exploration in the childbearing family area, such as

opportunities for shadowing nurse practitioners, certified nurse midwives and CRNA’s. Criteria: Uphold the standards and values of the profession including accepting responsibility for learning and personal growth.

Recommendation: What is essential must be winnowed from what would be nice (Emerson, 2007). N417 Gap: Consider fiscal presentation in post-conference to meet the variety of current evolving health care systems. Consider discussion board to

meet this objective. Criteria: Demonstrate knowledge of fiscal dimensions within a variety of current and evolving health care systems.

Recommendation: This content should be adequately covered in N408.

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Evaluation of Senior 1 Nursing Courses based upon AACN Baccalaureate Essentials

AACN Baccalaureate Essentials

Does current course

support, address, or link to:

N408 N412 N414 N415 N416 N417

1.Liberal education:

provides the cornerstone for the practice and education of nurses

I

Possible Gap: The analysis provided is not

specific in how the course addresses

critical thinking and reasoning skills. Are their opportunities to

increase broad knowledge base of

various populations? Can politics include exposure to other

health systems? For instance including

discussion on other countries and/or military, Native

American health systems, etc. would

meet needs to discuss cultural diversity, population health.

N/A

1 & 2. These are both identified as

“Not Applicable.” It seems the course

content does offer opportunities to address these

standards. A course on family

centered health care might incorporate

aspects from social sciences,

anthropology, genetics, etc. to increase student

exposure to varied “ways of

knowing.” Quality & safety can be addressed in

R

This analysis is not descriptive. There

may be opportunities to

expand liberal knowledge base such as

incorporating theories from

sociology, anthropology, psychology.

R

This standard is assessed as

sufficiently addressed.

Not addressed

This standard is not assessed

in the analysis.

R

These standards

were not separately

addressed in the analysis, but could be

gleaned from some of the

analysis in the CON evaluation

that this is adequately

addressed.

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context of problem-solving, improving access

to care, etc.

2. Basic organizational and systems leadership for

quality care and patient safety: Knowledge and skills in leadership, quality

improvement, and patient safety are necessary to

provide high quality health care.

I,R

Possible Gap:

The gap analysis does not specify whether

content is provided regarding the BSN role

in leadership of safety and quality initiatives. Addition of these

elements in discussion of leadership could be

beneficial.

N/A

(see above comments)

N/A (skills not a primary goal of

course)

It is stated that leadership skills are not a goal of this

course. It could be that the definition of

leadership and in fact, many opportunities exist

for nurses lead patient care quality

and safety.

R

This standard is assessed as

sufficiently addressed.

Not addressed

This standard is not assessed

in the analysis.

R

Gap:

Instruction on safety and

quality may be lacking.

3. Scholarship for evidence-based practice:

Professional nursing practice is grounded in the translation of current

evidence into one’s practice

I,R

Possible Gap: That PowerPoints provide references seems like

weak evidence of the incorporation of EBP

in this course. When articles are listed in the assignment, are these

highlighted as best practices? Are students

asked to find best practices in nursing leadership or examples

of nurses leading quality and safety

R

Evidence provided that this item is sufficiently

addressed.

R

Faculty state that more active use of EBP would be

preferred under the CON analysis, but

do not address this standard as deficient under the AACN

analysis. There are likely opportunities

to build more EBP usage into the normal course work

R

How EBP is incorporated is not well-

defined in the analysis.

R

This standard is assessed as sufficiently

addressed.

R

EBP is assessed as sufficiently

addressed.

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initiatives? If so, this could address and help meet AACN standards

under item #4 that is regarded as “Not

Applicable” in this gap analysis.

4. Information management and application of patient

care technology: Knowledge and skills in

information management and patient care technology are critical in the delivery

of quality patient care.

N/A

(see above comments)

N/A

Possible Gap: The gap analysis

states item 4 is “Not Applicable.” There may be

opportunities to include addressing

the organizing, retrieving, acquiring and

maintaining of information within

this course. It is also possible this is already

occurring and just not identified as

“information management.” In addition,

familiarity with data management

might be added to this course by asking students to

retrieve data on the topic of

N/A

Gap: The gap analysis states item

4 is “Not Applicable.” There may be

opportunities to include information

gathering on family health trends, for example morbidity

and mortality.

R

Assessed as meeting this

standard.

R

This is assessed as

sufficient, however only mentioned

patient care technology,

not information management.

R

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interest from sites such as CDC, World Health

Organization, etc.

5. Healthcare policy, finance, and regulatory

environments: 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.

I,R

Evidence seems sufficient that this standard is covered.

N/A

Possible Gap: These items are listed as “Not

Applicable.” It seems the course

content does address topics that may have related

policies and examples of

communication collaboration, such as those

surrounding pregnancy,

divorce, poverty, etc.

R (loosely)

Gap: Faculty identified gap; may be opportunities to

incorporate content.

R (loosely)

Gap: Standard is difficult to

address uniformly due

to varied student experiences.

Not

addressed.

Not assessed.

R

Gap: Policy is not specifically

addressed.

6. Inter-professional communication and

collaboration for improving patient health outcomes:

Communication and collaboration among healthcare professionals are

critical to delivering high quality and safe patient

care.

I,R

Evidence seems sufficient that this

standard is covered.

N/A

Possible Gap: These items are

listed as “Not Applicable.” It seems the course

content does address topics that

may have related policies and examples of

communication

R

Gap: Faculty identify this as a gap

and there is no evidence it is specifically

addressed. A course focused on child

health in the community should involve other adults,

perhaps in regard to

R

Evidence seems

sufficient that this standard is covered.

R

Assessed as sufficiently

addressed using SBAR techniiques.

R

Communication

opportunities seem sufficient.

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collaboration, such as those surrounding

pregnancy, divorce, poverty,

etc.

social services, teachers, etc

7. Clinical prevention and population health: 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.

I

Possible Gap: It is not

clear from the gap analysis whether this

standard addresses disease prevention and health promotion.

Incorporating safety or quality stories in this

segment could address nurses’ role in promoting health in

healthcare settings.

R (introduced at family level)

Evidence seems sufficient that this


R

Evidence seems

sufficient that this standard is covered.

R

Evidence

seems sufficient that

this standard is covered.

Not

addressed.

Not addressed in analysis.

R

Examples of

learning opportunities

across the healthcare continuum

appear to be addressed.

8. Professionalism and

professional values: Professionalism and the inherent values of altruism,

autonomy, human dignity, integrity, and social justice

are fundamental to the discipline of nursing.

I,R

Possible Gap: It is not clear from the gap analysis how social

justice and autonomy are incorporated into

the course.

R

Evidence seems sufficient that this standard is

covered.

R

Gap: Faculty identify that little actual practice is

allowed for these standards;

simulation may provide some opportunities.

R

Gap:

Inconsistent experiences for

students.

R

Addressed sufficient.

R

Professional values are addressed.

3/4/12 10:15 AM

20

9. Baccalaureate generalist nursing practice:

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. 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.

Learning opportunities, including direct clinical

experiences, must be sufficient in breadth and

depth to ensure the baccalaureate graduate attains these practice

focused outcomes and integrates the delineated

knowledge and skills into the graduate’s professional nursing

I,R

Possible Gap: It is

unclear how diversity and variation of

populations served are addressed in this course.

It is unclear why

managing care as part of an inter-professional team is listed as “Not

Applicable” in the gap analysis. Course

content includes conflict management, professional etiquette,

communication skills; all of these could be

provided in context of the inter-professional team.

It is unclear why

simulation experiences are listed as “Not Applicable” when

learning activities cite case studies, clinical

scenarios, and communication exercises. These all

could provide opportunities to for

simulation exercises.

R

Evidence seems

sufficient that most of this


It is listed as “Not Applicable” for many of the items

under this standard; there

may be a misperception of what can be

classified as simulation and

learning opportunities. The use of invited

guests could be one way of

incorporating more “clinical learning

opportunities.”

R

Gap: Opportunities

to demonstrate mastery through

clinical practice are needed.

R

N/A although clinical and theory instructors

collaborate to connect theory and

practice through clinical opportunities lab,

case studies, clinical conference and

simulation.

R

This standard

seems to be well-described

and addressed.

R

R

R

Some evidence

this standard is addressed.

Most bulleted points not specifically

addressed.

R

R

R

Clinical

scenarios and learning

opportunities appear to be sufficient.

R

R

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21

Summary of Gap Analysis and Recommendations:

AACN Baccalaureate Essentials

408. Overall, this course seems to cover many standards desired by the AACN Baccalaureate Essentials. It is possible that the gaps are not actual

gaps, but just not reflected in the limited information provided about this course for the analysis. Based on the information received, it appears there

are opportunities to strengthen the course alignment with the Essentials, with very little adjustment. Recommendations include:

1. Highlighting evidence-based leadership practices throughout the course so the concept of EBP and research is apparent throughout the course

content.

practice.

Clinical learning is

focused on developing and refining the knowledge and skills

necessary to manage care as part of an inter-

professional team.

Simulation experiences augment clinical

learning and are complementary to direct

care opportunities essential to assuming the role of the

professional nurse.

A clinical immersion

experience provides opportunities for

building clinical reasoning, management, and evaluation skills.

N/A

N/A

N/A

N/A

N/A However,

role playing becomes part of the seminar

process.

N/A

N/A

N/A

N/A

R

R

R

R

R

R

R

R

R

3/4/12 10:15 AM

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2. Ask students to search for examples of best practices of leadership and nurse-led safety or quality initiatives in the literature, thereby

increasing the opportunities to increase information management skills.

3. Consider that each assignment can “multi-task” to meet many layers of learning; for instance communication lessons can be within the

context of inter-professional teams, varied populations, and on topics of safety.

4. Increase opportunities to use simulation in group activities.

412. This course covers many standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are

opportunities to strengthen alignment by incorporating the following adjustments:

1. Incorporate aspects from social sciences, anthropology, genetics, etc. to increase student exposure to varied “ways of knowing.”

2. Quality and safety examples can be woven into course content.

3. Look for opportunities to include “information management” or “data management,” such as asking students to retrieve data on the course-related

topics from sites such as CDC, World Health Organization, etc. 4. Increase use of simulations that are imbedded in classroom settings and guest lecturers to facilitate clinically-relevant learning.

414. This course covers many standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are


1. Incorporate theories from social sciences, anthropology, psychology to increase student exposure to broad theoretical base and question

ethnocentric assumptions. 2. Incorporate more opportunities for promoting and identifying evidence-based practice. 3. Increase identifying leadership roles, using child-family health setting to find opportunities for nurses to lead in quality and safety improvements.

4. Question definitions of information management and include opportunities to seek data and new knowledge related to course content. 5. Weave inter-professional communication and policy lessons into course content.

415. This course covers most standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are


1. Find opportunities to Incorporate evidence-based practice and awareness of policy into course content.

2. Use class time to share knowledge from diverse student clinical settings so there is equality of exposure to new knowledge.

416. Several standards of AACN Baccalaureate Essentials were not addressed in the analysis. It is possible the standards are not understood, or the

faculty do not see evidence of them being present in the course. Based on the information available, it appears that there are opportunities to

strengthen alignment by incorporating the following adjustments:

1. Find opportunities to increase addressing missing standards including broad liberal education knowledge, information management, and health

policies.

3/4/12 10:15 AM

23

2. Expand opportunities for clinical and simulation learning.

417. Standards of AACN Baccalaureate Essentials were not specifically addressed in the analysis, however, could be gleaned from the College of

Nursing analysis provided. More detail is needed to adequately assess the standards. Based on the information availab le, it appears that there are


1. Find opportunities to increase directly addressing standards of safety, quality, and health policies.

Overall combined recommendations:

Across many courses there are opportunities to increase alignment with AACN Essentials of Baccalaureate standards. Specific attention could be

paid to incorporating lessons that demonstrate how leadership in both direct care and managerial positions may improve safety, quality, and

therefore, patient outcomes. Greater appreciation of the meaning of a “liberal education” might be needed in order to assure the incorporation of

non-nursing points of view into lessons. Faculty might look for opportunities to present health topics from the perspective of genetics,

physiology, anthropology, sociology, or other arts and sciences. Information management seems to be an area identified as a “gap” in many

courses. It is possible faculty do not understand the definition of this standard, or they do not see its relevance in their courses. There may be

opportunities to include greater appreciation for information management by addressing how nurses in all settings organize, retrieve, acquire and

maintain of information. In addition, faculty might include data management in their lesson plans by asking students to retrieve data on the topic

of interest from sites such as Centers for Disease Control, World Health Organization, or other collections of health data. To help meet multiple

standards that are desired by AACN and other agencies, faculty might consider how each assignment can “multi-task” to meet several learning

objectives; for instance communication lessons can be within the context of inter-professional teams, varied populations, and on topics of safety

or quality. All courses might increase opportunities to use simulation, particularly if there are insufficient or inconsistent clinical settings.

Evidence-based practice seems to be inconsistently addressed. All courses should be challenged to assure their content is evidence-based and

reinforce that students consider research, clinical experience, and patient preferences to provide care that aligns with current triad models of an

evidence-based practice.

3/4/12 10:15 AM

24





Evaluation of Senior 1 Nursing Courses based upon WSU Big 7 Goals

WSU Big 7 Goals:

Factors impacting

curricular

development

N408 N412 N414 N415 N416 N417

1. Critical and

creative thinking. Use reason, evidence and

context to increase knowledge, to reason ethically and to

innovate in imaginative ways.

I, R

R

R

R

See summa

ry below.

R

R

See summar

y below.

2. Quantitative

reasoning. Solve quantitative problems from a wide variety of

authentic contexts and everyday life

situations.

I

Standard not directly addressed in the faculty comments; however

course objective 4 is to examine fiscal resource

allocation and implication for health care. Working with budgets and resource

allocation is a quantitative issue.

N/A

Possible Gap: The faculty states this is N/A, however,

reinforcing the basics of statistics will aid

students in their review of research for EBP.

N/A

Possible Gap: May be opportunities to

stress the importance of

statistics when understanding research. This is

part of quantitative reasoning.

R R

R

3. Scientific literacy.

Have a basic understanding of major scientific

concepts and processes required for

I, R

R

R

R R

R

3/4/12 10:15 AM

25

personal decision making, participation in civic affairs,

economic productivity and

global stewardship.

4. Information literacy. Effectively identify, locate,

evaluate, use responsibly and share

information for the problem at hand.

I

R

R

R N/A

Possible Gap: Faculty state N/A,

however one must have information and

science literacy to effectively obtain and evaluate relevant data

to maintain an EBP. The faculty does state

this may be related to clinical documentation and

retrieval.

R

5. Communication. Write, speak and

listen to achieve intended meaning and understanding among

all participants.

I, R

R

R

R N/A

Gap: Faculty identify

this standard as a clinical goal. This can be added to the

curriculum because the students must

effectively communicate with each other and their

patients to perform safe, evidence-based

patient care.

R

6. Diversity. Understand, respect

and interact

I, R

Gap: Opportunities in this

class for the

R

R

R R

Gap: Opportunities

may exists for faculty

R

3/4/12 10:15 AM

26

Summary of gaps and recommendations:

N408: It is likely the Big Seven goals are covered in the N408 curriculum; this is just not emphasized in the faculty comments. For example, there

was not a connection between learning fiscal resource allocation and the use of quantitative reasoning.

Recommendation: Assure faculty understand how their coursework is linked to Big Seven goals.

N412: How the curriculum encompasses the Big Seven goals is well described in the faculty comments. The use of quantitative reasoning within the

class can be achieved by ensuring that students understand statistical analyses within the research.

constructively with others of similar and diverse cultures,

values, and perspectives.

communication techniques introduced in this class to teach students how to

respect and interact constructively with others.

to address diversity in the population of laboring mothers.

Not just ethnic or cultural, but the

students will have to work with babies born to drug addicted

mothers, teen mothers, and various

other “non-traditional” families.

7. Depth, breadth and integration of learning

for the benefit of themselves, their

communities, their employers and for society at large.

I, R

R

R

R R

Not addresse

d.

3/4/12 10:15 AM

27

N414: Again, the curriculum descriptions explain how it covers the Big Seven goals, the only issue being the lack of quantitative reasoning which

can be taught by reviewing the statistics of research.

N415: The faculty comments for this class and how it covers the Big Seven goals were extensive.

N416: Faculty notes give a brief description of how the curriculum covers the goals. The proposed curriculum may cover the goals better than is

explained by faculty comments.

Recommendation: Faculty will understand how “diversity” can included socioeconomics, non-traditional families, and differences other than

ethnicity. Use all opportunities to recognize and point out diversity to students.

N417: The faculty comments for this class and how it covers the Big Seven goals were extensive.

3/4/12 10:15 AM

28





Evaluation of Senior 1 Nursing Courses based upon Nursing Commission Requirements

Nsg Commission requirements: theory & practice in following areas:

N408 N412 N414 N415 N416 N417

Medical

nursing

I

? I/R/M

R (peds)

Addressed

N/A

R

Surgical nursing

I

? I/R/M

R (peds)

Addressed

N/A

R

Obstetric

nursing

I

? I/R/M

N/A N/A I

Addressed

Nursing of children

I

? I/R/M

R

Addressed

I

I

Community

and public health nursing

I

Possible gap: Unclear if this is addressed; Are concepts of power,

leadership styles/theories, teamwork

etc discussed in context of public health scenarios? Impact of

politics on community health resources

discussed?

? I/R/M

R

Addressed

I

R

History and health trends

I

Possible gap: Unclear if

addressed. Could be presented in context of

? I/R/M

Insufficient evidence to

assess this criteria.

R ? I/R/M

Does not appear to be

addressed.

R

3/4/12 10:15 AM

29

shifting sources of power in patient care delivery (MD, providers,

government, etc) and trends is leadership

related to patient care delivery models.

Legal and

ethical issues

I

Possible Gap: Unclear if addressed. May want to

include L/E issues examples in discussions about delegation, power,

collaboration, politics, leadership observations.

? I/R/M

R

Addressed

R

Does not appear to be addressed.

R

Assessment

and analysis of client and family

I

Not addressed

? I/R/M

R

Addressed

R

R

Implementation of care

I

Possible Gap: Might be addressed within

collaboration & delegation but unclear

from evidence provided.

? I/R/M

R

Addressed

R

Evaluation of care

I

Unclear if addressed.

Could be component of collaboration, delegation

& leadership styles

? I/R/M

Evidence unclear if this is

addressed; no reference to outcome assessment.

R

Addressed

R

No response

Delegation of nursing care

IR

? I/R/M

Appears to not be addressed ? I/R/M Appears to not be

? I/R/M

R

3/4/12 10:15 AM

30


N 408: Overview for this course indicates focus is on impact of leadership, management, and resource allocation on patient outcomes. Concepts of leadership presented through assignments, projects, discussion and simulated case studies. The connection of these with patient outcomes is not clear

from evidence provided. Assignments could incorporate impact of certain negotiated or delegated decisions on the delivery of care to specific patient population (minority, medical, OB, etc.) (may already be in place) which would satisfy additional criteria for the Nursing Commission standard.

addressed

Provide care for diverse groups

I

Not addressed

? I/R/M

R R

No response Appears to not

be addressed.

Safe, effective

care environment

I, R

? I/R/M

R

R

No response

Health

promotion Leadership and

management

I, R

? I/R/M R

N/A

R

N/A

No response

Parenteral therapies

N/A ? I/R/M

Unclear that this is

addressed.

R

Addressed

R

? I/R/M

Pain management

I

Not addressed

? I/R/M

Possible Gap: Unable to determine.

Pain management could be incorporated into one of the

clinical examples to satisfy this criterion.

R

Addressed

R

R

Working in a health care team

I, R, M

? I/R/M

Not addressed based on

available information.

R

Addressed

R

R

3/4/12 10:15 AM

31

Evolution of nurse’s political involvement to create change (advanced practice status, IV sedation, ANA, unions versus non-union) and historical trends in patient care delivery models could be incorporated into assignments.

N412: Course objectives suggest these topics are addressed but may need to be more clearly specified in a project or assignment: History and health trends; evaluation of care; delegation of nursing care; parenteral therapy; pain management; working in a health care team

N414: Delegation of nursing care may need to be emphasized via discussion, project etc. Leadership and management considered N/A by course

reviewer however these could be introduced in discussions about teaching parents how’s/why’s of child proofing their home (for example), or discharge planning implications for returning to school with conditions such as obesity or special needs such as asthma, diabetes, short bowel

syndrome, etc.

N415: Health history /trends and legal/ethical issues not clearly portrayed

N416: These areas are not clearly illustrated in course reviewers comments yet are undoubtedly incorporated into the care of the newborn, outpatient

care and in-home care of the family: Evaluation of care, Provide care for diverse groups

N417: History and health trends not clearly exemplified. Otherwise extensive documentation of coursework, projects, discussions as documented

within the CON Program Objectives section suggests these Nursing Commission criteria met.

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32





Evaluation of Senior 1 Nursing Courses based upon NCLEX

NCLEX test content/blueprint (effective April 2010) Processes integrated throughout curriculum: nursing process, caring, communication and documentation, teaching/learning 4 Client Needs categories (2 of the 4 divided into subcategories)

1. Safe and effective Care environment: Management of Care, Safety and infection Control 2. Health promotion and maintenance

3. Psychosocial integrity 4. Physiological integrity: Basic care and comfort, pharmacological and parenteral therapies reduction of risk potential, physiological

adaptation.

N408 N412 N414 N415 N416 N417

Safe and effective care

environment

The concept of safe

& effective care is

taught & practiced

in this course

Gap: Does not appear to be

addressed


addressed

Gap: Does not appear to

be addressed

Gap: Does not appear to be addressed

Recommendations: introduction to

clinical environment

Management of care

Gap: Not addressed

Recommendation:

define leadership & give examples of

professional responsibilities,

professional values,professional growth, define

resource allocation & factors involved

in present day budgetary limitations related to

legislation

Gap: Not addressed

Recommendation: Discuss & review client rights for

access of optimum health care,

Confidentiality related to pt. records, technology

for enhancing pt. health care ed.,

consultation services to provide holistic health care

Gap: Does not

appear to be addressed

Recommendation:

should be based on child growth

and development and generational stages of

development

Gap: Does

not appear to be addressed

Recommend

ations: safety practices in

the home, preventative care

practices, protective

measures to ensure safety from abuse

or neglect

Gap:

Recommendations proper car seats,

safety with regards to

products and formula


Recommendation: Policy and procedures for organization where student is in practicum

3/4/12 10:15 AM

33

Safety Gap: Does not appear to be addressed

Recommendations: Regulatory

mandates and scope of practice


Recommendations: preventative

measures and statistical evidence of illness and

trauma across the generations, safety

of chemical sand medications in the home


Recommendation: development of

national safety measures and policy related to

immunizations, food and drug

safety measures


Recommendations :

proper hygiene practices,

immunizations, primary

care established


Recommendation: Introduction to organizational codes and policy

related to safety at practicum site

Infection

control

Gap: Does not


Recommendation: CDC recommendations

and standards of care.

Gap: Does not


Recommendation: immunization and present day risk of

communicable disease. CDC

recommendations and school requirements for

students

Gap: Does not


Recommendation: Exposure to bacterial and viral

agents and preventative

measures, childhood illness, family illness

Gap: Does

not appear to be addressed

Recommendations : disease

prevention, wellness

practices,


Recommendation: Policy related to infection control and standards of care

within the clinical environment at practicum site

Health promotion

and maintenance

Gap: Not addressed Recommendation:

Promotion of client centered health care goals & quality

control measures for practicing nurses,

design quality care initiatives, political activism in change

of health care policy


addressed

Recommendations: explore family

resources for holistic health care

investigate socioeconomic constraints to health

care access


addressed

Gap: Does not appear to

be addressed Recommendations:

therapeutic communicati

on, family dynamics

Gap: Signs and

symptoms of PP depression;

bonding

Recommenda

tions: support resources for family


Recommendation: Health care

practices for families (acute care setting) or females along the continuum from premenstrual to post

menopause

3/4/12 10:15 AM

34

Psychosocial integrity


Recommendations: Patient’s right

advocacy, cultural sensitivity, social justice issues,

conflict resolution issues and decision

making


Recommendations: continuum of health

from prevention to holistic health maintenance.

Explore the impact of illness of family

lifestyle explore role of each family member when there

is chronic illness in family.


Recommendation: Content related to

nursing theory

Physiological

integrity

Gap: Does not

appear to be addressed Recommendation:

Health habits, Health maintenance

and preventative care

Gap: Does not


Gap: Does

not appear to be addressed Recommend

ations :

nutrition and

oral hydration, personal

hygiene, sleep habits


Recommendation: Assessment of clients psychosocial needs during clinical practicum with therapeutic

interventions and evaluations of interventions

Basic care

and comfort

Gap: Does not

appear to be

addressed

Recommendation:

Concepts of health care promotion and

preventative care

Gap: Does not

appear to be

addressed

Recommendations :

Gap: Does not

appear to be

addressed Recommendation:

nutrition, personal hygiene, rest and

sleep, comfort, mobility, elimination

Gap: Not

addressed Recommendations :

medication administratio

n, supplements, the 6 rights

Standard met. Gap: Does not appear to be

addressed Recommendation: documentation and report by student nurse reflects knowledge when

interpreting patient care plans, laboratory test results, diagnostic tests

and treatment plans for clients’

3/4/12 10:15 AM

35

Pharmacological and

parenteral therapies

Gap: Does not

appear to be

addressed

Recommendation: Scope of practice

Gap: Does not

appear to be

addressed

Recommendation: Explore non-

pharmaceutical interventions for fever control and

common cold symptom, explore

pain perception and physical symptoms , explore palliative

care , controlled substance use and

dependency

Gap: Does not

appear to be

addressed

Recommendation: medication

administration, medication safety, 6 rights

Gap: Does

not appear

to be

addressed Recommend

ations : normal vitals,

diagnostic tests,

laboratory values, therapeutic

procedures, potentials for

alteration in body systems and

complications related to

diagnostic tests and surgical

interventions

Standard met. Gap: Does not appear to be

addressed Recommendation: Care of patient antepartum, during labor and

delivery and postpartum client and neonate or care of families-all

generations

Reduction of risk potential

Gap: Not ddressed

Recommendation:

Utilization of new technology to improve patient care

outcomes, EMR, knowledge of

healthcare policy, practices grounded in evidence based

research

Gap: Does not

appear to be

addressed

Recommendation: education of patient

concerning treatments and

procedures, diagnostic testing, explore trends with

lab results

Gap: Does not

appear to be

addressed Recommendation: Parental

responsibilities laws that protect

and regulate care of minors

R Standard met. Gap: Does not appear to be


Antepartum supplements. Medications common to the postpartum population

3/4/12 10:15 AM

36

Physiological adaptation

Gap: Does not

appear to be

addressed

Recommendation:

Gap: Does not

appear to be

addressed

Recommendations: identify chronic

illness and underlying pathophysiology

and treatment protocols

Gap: Does not

appear to be

addressed

Recommendation: illness and

management of care

R Standard met. Gap: Does not appear to be


Nursing

process

Gap: Does not

appear to be

addressed

Recommendation:

integration throughout course,

evaluation formative an summative

Standard met. Gap: Does not

appear to be


Case studies exploring nursing

process for children and family members

R Gap: Does

not appear

to be

addressed

Recommendation: explore

nurse caring

behaviors

during

interventions

with client

population



Caring Standard met. Gap: Does not

appear to be

addressed

Recommendations: diversity of client

population review of cultural sensitivity and

generational considerations

Gap: Does not

appear to be

addressed

Recommendation: Caring practice

within the family unit referrals for parenting classes

R Gap: Does

not appear

to be

addressed

Recommenda

tion: communication and

documentation integrated

in client need categories. Introduction

to electronic


addressed Recommendation: Client care assessments and assignment that

assist in evaluating the student’s knowledge of the nursing process

3/4/12 10:15 AM

37


N408: It appears that the only concept addressed in the faculty comment is that of safe and effective care.

Recommendations: Strategies could include assignments which focus on guiding and evaluating client care, evidence based research skills, client’s rights, conflict management, confidentiality, documentation, workload management, ethical dilemmas, informed consent, information technology,

medical records, written

assignments reflect

standards of care.

Communication and

documentation

Standard met. Gap: Does not

appear to be

addressed

Recommendation:

Gap: Does not

appear to be


communication appropriate for developmental

stage evidenced by documentation

in assigments

R Gap: Does

not appear

to be

addressed

Recommend

ation: Recommenda

tion: Strategies

could involve case studies, concept

mapping, discussion

forums


addressed Recommendation: Caring

practice based on theories of caring Watson or Leininger

Teaching/learning

Standard met. Standard met. Standard met. R Standard met. Gap: Does not appear to be

addressed Recommendation: Documentation on client care records

and communication evaluated with interactive process

( students’ communication with allied health team and clients)

3/4/12 10:15 AM

38

electronic medical records, skills assessment and evaluation, state and federal regulations, legal scope of practice, medical referrals, supervision, performance evaluation and the reporting of unsafe practice.

And, how is “resource allocation on patient outcomes” (which includes people, materials, plant and equipment, money, and information) addressed?

N412: Faculty Comment: The value in the seminar is to encourage students to translate knowledge into applicable nursing process that may be

“outside the box”. All reinforce areas are incorporated into creative case studies and class content for interactive learning.

Recommendations: above

N414: The faculty comments do not define curriculum other than to state that content is adapted to child and family health, and that exam questions are written in NCLEX style. There is a brief comment regarding teaching and learning.

Recommendations: Above

N415: Single faculty comment: “as above, content adapted to emphasize pediatric/family care”.

Recommendations: See above; written based on NCLEX test plan.

N416: Summary: Although caring, communication and documentation, and teaching and learning are processes that should be integrated throughout the client needs categories and subcategories, nursing process is the only one of 4 mentioned in this course.

Recommendations: Above

N417 The faculty comment section was empty.

Recommendations: above

3/4/12 10:15 AM

39





Review of Senior 1 Nursing Courses to QSEN

Other professional standards – QSEN

N408 N412 N414 N415 N416 N417

Patient Centered Care -

Recognize the patient or

designee as the source of

control and full partner

in providing

compassionate and

coordinated care based

on respect for patient’s

preferences, values and

needs

I, R

No evidence

provided.

X

R

M

R

Note evaluated, but implied in other evaluations as care focuses on the

family and cultural contexts

Teamwork and

Collaboration - Function effectively within nursing

and inter-professional teams, fostering open

communication, mutual respect, and shared decision-making to

achieve quality patient care

This competency was missing from the evaluation form. Evidence

obtained from CON “Role

Not rated.

“Describe the techniques for

conflict management,

active listening, negotiations,

and delegation that are usable

and transferable in nursing

practice and

Not rated.

Considered “N/A” in

relevant CON and AACN

criteria.

Not rated.

“discuss case management

and community

resources, collaboration with other

pros such as child life,

PT/OT etc” “more time for other

disciplines to

Not rated.

“roles of other professionals

in health care” but “Gap may

be opportunities for all students

to experience much

interdisciplinary interactions.”

Not rated.

“SBAR communicati

on and exam/case

studies”

Not rated.

Opportunities to shadow other professionals, although this is not

truly inter-disciplinary. Gap identified “consider more independent

opportunities for role exploration”

3/4/12 10:15 AM

40

Development” and AACN #6

personal interactions. Describe the

concept of servant

leadership and how that bridges into

nursing practice. The

servant leadership project will

give the students the

opportunity to practice teamwork

skills and volunteering

process”

interact with students in classroom

format would be great—

however they do have that opportunity

in the associated

clinical course.” value of other

professional collaboration

threaded in content when applicable

Consider adding an

objective to course relative to

Interprof. collaboration

incorporating info into case studies. The

students do get this

emphasized in their clinical

course related to N414

3/4/12 10:15 AM

41


408. Professional Development III: Leadership and Management. This course covered several of the QSEN competencies. The evaluator listed

general evidence from course objectives or activities but did not make specific linkages between objectives and QSEN competencies. For example,

“Identify positive and negative communication styles in the student’s personal and professional lives” was offered as an example of QSEN, but it

Evidence-based Practice

(EBP)-Integrate best

current evidence with

clinical expertise and

patient/family

preferences and values

for delivery of optimal

health care

I, R.

Standard met. R

R.

R.

Standard met.

Quality Improvement

(QI)-Use data to monitor

the outcomes of care

processes and use

improvement methods to

design and test changes

to continuously improve

the quality and safety of

health care systems

I. No

evidence provided

N/A N/A.

Gap:

“Students do

not have the opportunity to practice

quality improvement.

”

N/A.

Possible Gap: Little

opportunity exists for continuous

improvement monitoring.

N/A Possible gap: Not indicated in

evaluations. Could be addressed through focused group activities

examining QI data from the setting.

Safety-Minimizes risk of

harm to patients and

providers through both

system effectiveness and

individual performance

I Standard met. R

R

R

Possible gap: Safety not mentioned in evaluation. Could be modeled through drills for emergency response,

proper medication safety, procedures for infant identification, etc.

Informatics-Use

information and

technology to

communicate, manage

knowledge, mitigate

error, and support

decision-making

I. No evidence

provided

N/A N/A R

N/A Standard met.

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does not align with a specific QSEN competency. Evidence for QSEN competencies was found in this course’s evaluation within other frameworks.

It is possible that since QSEN was the last framework on the evaluation tool, evaluation fatigue had overtaken the instructor.

Recommendation: strengthen the linkage between existing course content and QSEN competencies, focusing on informatics and quality

improvement.

412. Family and Community as Context of Care. This course was strongly aligned with three QSEN competencies (evidence-based care, patient-

centered, and safety). Teamwork and Collaboration was considered not applicable, although it is difficult to support this position.

Recommendation: identify existing content or incorporate new content that supports Teamwork and Collaboration.

414. Child and Family Health Theory. This course was strong in incorporating patient-centered care, evidence-based practice, and safety.

Interprofessional collaboration was identified as a gap, although there are opportunities in the associated practice course, N 415.

Recommendation: Add a course objective for Teamwork and collaboration.

415. Children and Families as the Focus of Nursing Care. This is the practice course to accompany N 414. As a practicum it has inherent strengths

in incorporating evidence-based practice, informatics (EHR), safety, and patient-centered care. Teamwork and Collaboration, and Quality

Improvement were identified gaps.

Recommendation. Add course objectives for Teamwork and collaboration and identify ways to incorporate interprofessional education into

the clinical rotation systematically, for example with interdisciplinary rounds.

416. Childbearing Health of the Family. This didactic course had strengths in evidence-based practice, and patient-centered care. Teamwork and

Collaboration and Safety had limited evidence of incorporation. Informatics and QI were considered N/A.

Recommendation. Strengthen interprofessional and safety components in course.

417. QSEN ratings missing from the faculty evaluation. Inferences were made from other frameworks and from personal knowledge of content area.

Teamwork and collaboration, QI and Safety were evident as gaps.

Recommendation. Increase teamwork and collaboration with inter-professional patient rounds; develop QI project that examines site-

specific data on a relevant clinical measure; and safety could be practiced with emergency drills or simulation.

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One of the 6 QSEN competencies, Teamwork and Collaboration, was not included in the course assessments. Given the increasing emphasis on

inter-professional education and practice and other forms of collaboration, this is an important area to address within the undergraduate curriculum.

Recommendation: revise needs assessment form to include Teamwork and Collaboration.

There is overlap between QSEN competencies and other frameworks used in this evaluation. It may be more efficient to combine categories across

frameworks. For example, CON program outcomes, Role Development includes “Partner with clients, families, communities and interdisciplinary

health care teams to design and provide quality health care” which aligns with QSEN’s Teamwork and Collaboration. Similarly, CON program

outcomes, Designer and Manager of Care includes “Use evolving information technology to monitor and improve the health care of clients” which

aligns with QSEN’s Informatics.

Table of QSEN competencies overlapping in other frameworks:

QSEN Competency Other Frameworks

Patient Centered Care

Teamwork and Collaboration CON (Role Development) AACN (#6)

Evidenced Based Practice AACN (#3)

Quality Improvement AACN (#2)

Safety AACN (#2)

Informatics CON (Designer and Manager of Care)

AACN (#4)

Recommendation: Integrate QSEN competencies into other frameworks in order to reduce the work of conducting this evaluation.

There is limited opportunity for inter-professional collaboration in education or practice.

Recommendation: incorporate more opportunities for inter-professional education and practice throughout the semester’s courses.

Quality Improvement and Informatics content were virtually nonexistent throughout the semester’s courses

Recommendation: systematically identify ways to increase QI and informatics throughout the curriculum.

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Evaluative summary of gaps and recommendations based upon WSU Big 7, Nursing Commission,

NCLEX, CON, QSEN and AACN Baccalaureate Essentials criteria

N408 Professional Development: III Leadership and Management


Overview for this course indicates focus is on impact of leadership, management, and resource allocation on patient outcomes. Concepts of leadership presented through assignments, projects, discussion and simulated case studies. The connection of these with patient outcomes is not clear

from evidence provided. Assignments could incorporate impact of certain negotiated or delegated decisions on the delivery of care to specific patient population (minority, medical, OB, etc.) (may already be in place) which would satisfy additional criteria for the Nursing Commission standard.

Evolution of nurse’s political involvement to create change (advanced practice status, IV sedation, ANA, unions versus non-union) and historical trends in patient care delivery models could be incorporated into assignments.

NCLEX (National Council of State Boards of Nursing)

It appears that the only concept addressed in the faculty comment is that of safe and effective care.

Recommendations: Strategies could include assignments which focus on guiding and evaluating client care, evidence based research skills, client’s rights, conflict management, confidentiality, documentation, workload management, ethical dilemmas, informed consent, information technology, electronic medical records, skills assessment and evaluation, state and federal regulations, legal scope of practice, medical referrals, supervision,

performance evaluation and the reporting of unsafe practice.

How is “resource allocation on patient outcomes” (which includes people, materials, plant and equipment, money, and information) addressed?


Overall, this series of four courses in Leadership & Management should be updated to reflect the recommendations from the Institute of Medicine’s

The Future of Nursing (RWJ/IOM, 2011) and recent changes in the healthcare industry, such as “Pay-for-Performance” (U.S. Department of Health

& Human Services, 2006). Important topics such as quality improvement, cost-benefit analyses, employee hiring/firing, staff development, and

principles of nursing workload need to be incorporated (American Nurses Association, 2008). We refer faculty to the excellent discussion on pages

251-256, “Skills for the Managed Care Environment: Leadership and Management” in Nursing Education in the Clinical Setting (Emerson, 2007).

The following is a list of the faculty- identified gaps with the associated criteria followed by a recommendation:

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Faculty report a need to invite more of the CON affiliate community nurse leaders. Criteria: Provide compassionate, ethical care to individuals of diverse cultures, values, beliefs, and lifestyles.

Recommendation: Invitations could be extended to CON-affiliated nurses who are leaders of healthcare organizations that specifically provide care

to people of diverse cultures, values, beliefs, and lifestyles in the community.

Faculty report difficultly to get students freely talking in large lecture classes of 125-135 students.

Criteria: Protect the rights of people to receive optimum care and make informed decisions affecting their health welfare.

Recommendation: Discussion of such a sensitive topic might be more effective if the students are divided into small groups for case study reviews and role-playing. Classroom Response Systems (“clickers”) might also be useful to aggregate data from such a large group: “Faculty can pose

case studies or clinical problems and ask students for their opinions. Differences in answers can be discussed (O'Neil, 2009, p. 172).

Faculty report on inconsistency in reception of topic: “Politics is sometimes a hot button with some cold and boring button for others.”

Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care Recommendation: Specific case studies that describe and report on the sometimes dramatic consequences of political decisions on healthcare could be reviewed by students in an online discussion board as part of a hybrid learning environment. Students could also submit reflections online.

Faculty report: “It is difficult in a 3 hour class of over 130 young adult learners to capture their attention and interest. Several teaching tools are used, i.e. YouTube, PPT, group exercises, guest speakers and websites.”

Criteria: Demonstrate knowledge of fiscal dimensions within a variety of current and evolving health care systems. Recommendation: Fiscal responsibility is a vitally important topic. After graduation, baccalaureate-prepared nurses are often required to be “in

charge”. Those RN’s who do not manage within the constraints of the budget can lose their job. As a class project, different student groups could be assigned to an area of responsibility within a variety of health care systems. Real life scenarios that impact the budget could be presented, and the students would have to problem-solve based upon their knowledge of fiscal dimensions. Examples could include community health clinics, or an

inpatient medical/surgical unit. “A student who expects the world to correspond with the ideal will inevitably be disappointed. If students are able to work only under ideal circumstances, they have been sadly unprepared for reality” (Emerson, 2007, p. 252).


This course covered several of the QSEN competencies. The evaluator listed general evidence from course objectives or activities but did not make

specific linkages between objectives and QSEN competencies. For example, “Identify positive and negative communication styles in the student’s

personal and professional lives” was offered as an example of QSEN, but it does not align with a specific QSEN competency. Evidence for QSEN

competencies was found in this course’s evaluation within other frameworks. It is possible that since QSEN was the last framework on the

evaluation tool, evaluation fatigue had overtaken the instructor.

Recommendation: strengthen the linkage between existing course content and QSEN competencies, focusing on informatics and quality

improvement.

AACN Baccalaureate Essentials (American Colleges of Nursing, 2008)

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Overall, this course seems to cover many standards desired by the AACN Baccalaureate Essentials. It is possible that the gaps are not actual gaps, but just not reflected in the limited information provided about this course for the analysis. Based on the information received, it appears there are

opportunities to strengthen the course alignment with the Essentials, with very little adjustment. Recommendations include: 1. Highlighting evidence-based leadership practices throughout the course so the concept of EBP and research is apparent throughout the course content.

2. Ask students to search for examples of best practices of leadership and nurse-led safety or quality initiatives in the literature, thereby increasing the opportunities to increase information management skills.

3. Consider that each assignment can “multi-task” to meet many layers of learning; for instance communication lessons can be within the context of inter-professional teams, varied populations, and on topics of safety. 4. Increase opportunities to use simulation in group activities.

N412: Family and Community as a Context of Care

WSU Big 7 (Office of Assessment of Teaching & Learning, 2011)

How the curriculum encompasses the Big Seven goals is well described in the faculty comments. The use of quantitative reasoning within the class

can be achieved by ensuring that students understand statistical analyses within the research.


Course objectives suggest these topics are addressed but may need to be more clearly specified in a project or assignment: History and health trends; evaluation of care; delegation of nursing care; parenteral therapy; pain management; working in a health care team


Faculty Comment: The value in the seminar is to encourage students to translate knowledge into applicable nursing process that may be “outside the box”. All reinforce areas are incorporated into creative case studies and class content for interactive learning.

Discuss & review client rights for access of optimum health care, Confidentiality related to pt. records, technology for enhancing pt. health

care ed., consultation services to provide holistic health care

Preventative measures and statistical evidence of illness and trauma across the generations, safety of chemical sand medications in the home

Immunization and present day risk of communicable disease. CDC recommendations and school requirements for students

Explore family resources for holistic health care investigate socioeconomic constraints to health care access

Continuum of health from prevention to holistic health maintenance. Explore the impact of illness of family lifestyle explore role of each

family member when there is chronic illness in family.

Explore non-pharmaceutical interventions for fever control and common cold symptom, explore pain perception and physical symptoms ,

explore palliative care , controlled substance use and dependency

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Education of patient concerning treatments and procedures, diagnostic testing, explore trends with lab results

Identify chronic illness and underlying pathophysiology and treatment protocols

Diversity of client population review of cultural sensitivity and generational considerations


This course was strongly aligned with three QSEN competencies (evidence-based care, patient-centered, and safety). Teamwork and Collaboration

was considered not applicable, although it is difficult to support this position.

Recommendation: identify existing content or incorporate new content that supports Teamwork and Collaboration.


This course covers many standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are opportunities to strengthen alignment by incorporating the following adjustments: 1. Incorporate aspects from social sciences, anthropology, genetics, etc. to increase student exposure to varied “ways of knowing.”

2. Quality and safety examples can be woven into course content. 3. Look for opportunities to include “information management” or “data management,” such as asking students to retrieve data on the course-related

topics from sites such as CDC, World Health Organization, etc. 4. Increase use of simulations that are imbedded in classroom settings and guest lecturers to facilitate clinically-relevant learning.

N414 Child and Family Health Theory


The curriculum descriptions explain how it covers the Big Seven goals, the only issue being the lack of quantitative reasoning which can be taught by

reviewing the statistics of research.


Delegation of nursing care may need to be emphasized via discussion, project etc. Leadership and management considered N/A by course reviewer however these could be introduced in discussions about teaching parents how’s/why’s of child proofing their home (for example), or discharge planning implications for returning to school with conditions such as obesity or special needs such as asthma, diabetes, short bowel syndrome, etc.


The faculty comments do not define curriculum other than to state that content is adapted to child and family health, and that exam questions are written in NCLEX style. There is a brief comment regarding teaching and learning.

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Faculty report a need for more time for class discussion and case studies with more individual written work. Difficult to do small groups over AMS, and workload of correcting case studies is huge.


Recommendation: Students can review the case study and formulate responses online prior to class. During class, faculty can pose a question and ask for responses using a Classroom Response System (“clickers”). This information provides faculty with an assessment of understanding the material and with discussion material. If the students understand the material, the faculty can move to the next topic. If students do not, the faculty

can ask students to confer and respond a second time. Discussions can be based on student answers (O'Neil, 2009, p. 172).

Faculty report “More active use of EBP by students would be beneficial”.

Criteria: Formulate nursing practice decisions using evolving knowledge and research from nursing science, the biological and behavioral sciences, and the humanities.

Recommendation: “It is incumbent upon nurse educators to provide the theoretical foundations for evidence-based practice. To accomplish this, nurse educators must refurbish curricula to incorporate both the pertinent new and expanded theory in the classroom and relevant practice in the most applicable clinical settings” (Emerson, 2007, p. 252). Therefore, it is recommended that case studies be presented that would require the students to

research evidence-based practice. For example, what would be best practice for management of a child with recurrent episodes of asthma, or uncontrolled diabetes? See above recommendation for evaluation of learning.

Faculty report a possible gap may be the lack of evaluation of competencies in this category. Faculty report there is no opportunity for actual observation or practice, but extra credit assignment often brings these out.

Criteria: Provide compassionate, ethical care to individuals of diverse cultures, values, beliefs, and lifestyles. Recommendation: This would, in fact, be difficult to measure during a theory class. However, “One single learning environment cannot encompass all of the knowledge and skills opportunities, but the clinical education experiences of the curriculum taken as a whole should” (Emerson, 2007, p.

254). A self-assessment tool may also be beneficial. “Self-assessment is critical to the process: It is the students, not the instructors, who are the ultimate arbitrators of the learning experience. The learning environment is one of mutual respect, collaboration, cooperation, and support” (Candela,

2006).

Faculty report there is a lack of direct practice experience in advocacy for underserved or vulnerable populations. Criteria: Demonstrate the values central to nursing practice including: altruism, autonomy, human dignity, integrity, and social justice.

Recommendation: Same as above, “One single learning environment cannot encompass all of the knowledge and skills opportunities, but the clinical education experiences of the curriculum taken as a whole should” (Emerson, 2007, p. 254). In class role-playing and case study exercises could also

be evaluated to bring out any possible problem areas.

Faculty note a possible gap may be that this standard is difficult to measure.

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Criteria: Advocate for responsible, humane health care policies. Recommendation: Self-assessment is critical to the process. It is the students, not the instructors, who are the ultimate arbitrators of the learning

experience. The learning environment is one of mutual respect, collaboration, cooperation, and support (Candela, 2006). However, also recall that: Nurses are already committed to delivering high-quality care under current regulatory, business, and organizational conditions. But the power to change those conditions to deliver better care does not rest primarily with nurses, regardless of how ably led or educated they are; it also lies with

governments, businesses, health care institutions, professional organizations and other health professionals, and the insurance industry (RWJ Foundation/Institute of Medicine, 2010).

Faculty report “More time for other disciplines to interact with students in classroom format would be great-however they do have that opportunity in their associated clinical course.”

Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care. More interdisciplinary interactions may be provided by increasing on campus interdisciplinary educational opportunities. In class communication, conflict resolution, and role-playing skills could also be utilized. Students could also be involved in developing interdisciplinary clinical pathways

and quality improvement activities.

Faculty report a lack of opportunity to actually participate in policy revision.

Criteria: Participate in revision of health care policy and practice within a rapidly changing global environment. Recommendation: It may not be realistic for students to actually participate in policy revision, however, students could be engaged in class

discussions about this topic.


This course was strong in incorporating patient-centered care, evidence-based practice, and safety. Interprofessional collaboration was identified as a

gap, although there are opportunities in the associated practice course, N 415.

Recommendation: Add a course objective for Teamwork and collaboration.

AACN Baccalaureate Essentials (American Colleges of Nursing, 2008) This course covers many standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are


1. Incorporate theories from social sciences, anthropology, psychology to increase student exposure to broad theoretical base and question ethnocentric assumptions.

2. Incorporate more opportunities for promoting and identifying evidence-based practice. 3. Increase identifying leadership roles, using child-family health setting to find opportunities for nurses to lead in quality and safety improvements. 4. Question definitions of information management and include opportunities to seek data and new knowledge related to course content.

5. Weave inter-professional communication and policy lessons into course content.

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N415 Children and Families as the Focus of Nursing Care


The faculty comments for this class and how it covers the Big Seven goals were extensive.


Health history /trends and legal/ethical issues not clearly portrayed


Single faculty comment: “as above, content adapted to emphasize pediatric/family care”.


Discrepancy among clinical groups in their opportunities for equal experiences for the students (Pediatric opportunities vary from site to site and community to community). Criteria: Provide competent nursing care to individuals, families, groups and communities through promotion, maintenance and restoration of

health; prevention of illness, and physical, emotional, and spiritual support throughout life the span. Recommendation: This is not specifically a curricula-related issue. It is a challenge faced by many schools of nursing due to a shortage of

available clinical sites. Some schools have made attempts for students to identify their preference of clinical site based upon their long term professional goals. For example, a student interested in pursuing a career in community health nursing may indicate a preference for an outpatient setting.

Challenge is that students’ prerequisite development courses vary considerably so everyone comes with a different base knowledge in human development.

Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to improve the quality of their nursing care.

Recommendation: Encourage SON to review course sequencing and to mandate appropriate course prerequisites.

Lack of consistency of content among various clinical groups, as often topics come up as a result of the experiences they have in clinical.

Criteria: Provide compassionate, ethical care to individuals of diverse cultures, values, beliefs, and lifestyles. Recommendations: Not every clinical learning opportunity will be available to every student, but concepts related to this criterion should be addressed during group discussions.

Inconsistent opportunities for all students to experience much interdisciplinary interactions . Criteria: Partner with clients, families, communities and interdisciplinary health care teams to design and provide quality health care.

Recommendation: Again, since clinical learning experiences are variable, more interdisciplinary interactions may be provided by increasing on campus interdisciplinary educational opportunities. In class communication, conflict resolution, and role-playing skills could also be utilized.

Faculty report clinical experiences for students vary from agency to agency so there is a disparity of IT experience when on site.

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Criteria: Use evolving information technology to monitor and improve the health care of clients. Recommendation: If the school can provide the student with basic technology skills, on-the-job training will provide the specific skills needed

once hired by an agency.


This is the practice course to accompany N 414. As a practicum it has inherent strengths in incorporating evidence-based practice, informatics

(EHR), safety, and patient-centered care. Teamwork and Collaboration, and Quality Improvement were identified gaps.

Recommendation. Add course objectives for Teamwork and collaboration and identify ways to incorporate interprofessional education into

the clinical rotation systematically, for example with interdisciplinary rounds.


This course covers most standards desired by the AACN Baccalaureate Essentials. Based on the information available, it appears that there are


1. Find opportunities to incorporate evidence-based practice and awareness of policy into course content.

2. Use class time to share knowledge from diverse student clinical settings so there is equality of exposure to new knowledge.



Faculty notes give a brief description of how the curriculum covers the goals. The proposed curriculum may cover the goals better than is explained

by faculty comments.


These areas are not clearly illustrated in course reviewers comments yet are undoubtedly incorporated into the care of the newborn, outpatient care and inhome care of the family: Evaluation of care, Provide care for diverse groups


Summary: Although caring, communication and documentation, and teaching and learning are processes that should be integrated throughout the

client needs categories and subcategories, nursing process is the only one of 4 mentioned in this course.

Proper car seats, safety with regards to products and formula

Signs and symptoms of PP depression; bonding Recommendations: support resources for family

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Explore nurse caring behaviors during interventions with client population

Signs and symptoms of PP depression; bonding

Support resources for family

Communication and documentation integrated in client need categories. Introduction to electronic medical records, written assignments reflect standards of care.

Strategies could involve case studies, concept mapping, discussion forums


Lack of practical exposure to diverse groups due to population encountering and student population. Criteria: Provide competent nursing care to individuals, families, groups and communities through promotion, maintenance and restoration of health;

prevention of illness, and physical, emotional, and spiritual support throughout life the span. Recommendation: “One single learning environment cannot encompass all of the knowledge and skills opportunities, but the clinical education

experiences of the curriculum taken as a whole should” (Emerson, 2007, p. 254).

Access to new knowledge is curtailed as budget cuts in library have begun to be a challenge in terms of obtaining some articles.

Criteria: Formulate nursing practice decisions using evolving knowledge and research from nursing science, the biological and behavioral sciences, and the humanities. Recommendation: This is not specifically a curricula-related issue. It is more of an administrative challenge faced by many schools of nursing due to

a shortage of resources. In the interim, there may be a need to revert to alternative methods to obtain articles until the problem is resolved. This is an area in which Dr. Doutrich is particularly skilled.

Faculty report “More likely to see in clinical portion – or leadership for assisting colleagues.” Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to improve the quality of their nursing care.

Recommendation: Assure that appropriate patient education teaching principles are incorporated into the course so that students are prepared to help clients achieve their health goals and assist colleagues to improve the quality of their nursing care when they are in the clinical setting.


This didactic course had strengths in evidence-based practice, and patient-centered care. Teamwork and Collaboration and Safety had limited

evidence of incorporation. Informatics and QI were considered N/A.

Recommendation. Strengthen interprofessional and safety components in course.


Several standards of AACN Baccalaureate Essentials were not addressed in the analysis. It is possible the standards are not understood, or the faculty

do not see evidence of them being present in the course. Based on the information available, it appears that there are opportunities to strengthen

alignment by incorporating the following adjustments:

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1. Find opportunities to increase addressing missing standards including broad liberal education knowledge, information management, and health policies.

2. Expand opportunities for clinical and simulation learning.

417 Nursing Care of Childbearing Families


The faculty comments for this class and how it covers the Big Seven goals were extensive.


History and health trends not clearly exemplified. Otherwise extensive documentation of coursework, projects, discussions as documented within the

CON Program Objectives section suggests these Nursing Commission criteria met.


The faculty comment section was empty,

Policy and procedures for organization where student is in practicum

Health care practices for families (acute care setting) or females along the continuum from premenstrual to post menopause

Assessment of clients psychosocial needs during clinical practicum with therapeutic interventions and evaluations of interventions

Assessment of clients psychosocial needs during clinical practicum with therapeutic interventions and evaluations of interventions

Documentation and report by student nurse reflects knowledge when interpreting patient care plans, laboratory test results, diagnostic tests

and treatment plans for clients’

Care of patient antepartum, during labor and delivery and postpartum client and neonate or care of families-all generations

Antepartum supplements. Medications common to the postpartum population

Client care assessments and assignment that assist in evaluating the student’s knowledge of the nursing process

Caring practice based on theories of caring Watson or Leininger

Documentation on client care records and communication evaluated with interactive process (students communication with allied health team

and clients)


Consider woman’s health issues including menopause.


Recommendation: This would be an appropriate consideration.

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Consider specific teaching project. Criteria: Use developmentally appropriate teaching- learning principles to assist clients to achieve their health goals and to assist colleagues to

improve the quality of their nursing care. Recommendation: There are already many effective evaluation strategies already in use for this course,

Faculty ask that consideration be given to more independent opportunities for role exploration in the childbearing family area, such as opportunities for shadowing nurse practitioners, certified nurse midwives and CRNA’s.

Criteria: Uphold the standards and values of the profession including accepting responsibility for learning and personal growth. Recommendation: What is essential must be winnowed from what would be nice (Emerson, 2007).

Consider fiscal presentation in post-conference to meet the variety of current evolving health care systems. Consider discussion board to

meet this objective. Criteria: Demonstrate knowledge of fiscal dimensions within a variety of current and evolving health care systems.

Recommendation: This content should be adequately covered in N408.


QSEN ratings missing from the faculty evaluation. Inferences were made from other frameworks and from personal knowledge of content area.

Teamwork and collaboration, QI and Safety were evident as gaps.

Recommendation. Increase teamwork and collaboration with interprofessional patient rounds; develop QI project that examines site specific

data on a relevant clinical measure; and safety could be practiced with emergency drills or simulation.


Standards of AACN Baccalaureate Essentials were not specifically addressed in the analysis, however, could be gleaned from the College of

Nursing analysis provided. More detail is needed to adequately assess the standards. Based on the information available, it appears that there are opportunities to strengthen alignment by incorporating the following adjustments:

1. Find opportunities to increase directly addressing standards of safety, quality, and health policies.

Across many courses there are opportunities to increase alignment with AACN Essentials of Baccalaureate standards. Specific attention could be

paid to incorporating lessons that demonstrate how leadership in both direct care and managerial positions may improve safety, quality, and

therefore, patient outcomes. Greater appreciation of the meaning of a “liberal education” might be needed in order to assure the incorporation of non-

nursing points of view into lessons. Faculty might look for opportunities to present health topics from the perspective of genetics, physiology,

anthropology, sociology, or other arts and sciences. Information management seems to be an area identified as a “gap” in many courses. It is possible

faculty do not understand the definition of this standard, or they do not see its relevance in their courses. There may be opportunities to include

greater appreciation for information management by addressing how nurses in all settings organize, retrieve, acquire and maintain of information. In

addition, faculty might include data management in their lesson plans by asking students to retrieve data on the topic of interest from sites such as

Centers for Disease Control, World Health Organization, or other collections of health data. To help meet multiple standards that are desired by

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AACN and other agencies, faculty might consider how each assignment can “multi-task” to meet several learning objectives; for instance

communication lessons can be within the context of inter-professional teams, varied populations, and on topics of safety or quality. All courses might

increase opportunities to use simulation, particularly if there are insufficient or inconsistent clinical settings. Evidence-based practice seems to be

inconsistently addressed. All courses should be challenged to assure their content is evidence-based and reinforce that students consider research,

clinical experience, and patient preferences to provide care that aligns with current triad models of an evidence-based practice.

One of the 6 QSEN competencies, Teamwork and Collaboration, was not included in the course assessments. Given the increasing

emphasis on interprofessional education and practice and other forms of collaboration, this is an important area to address within the

undergraduate curriculum. Recommendation: revise needs assessment form to include Teamwork and Collaboration.

There is overlap between QSEN competencies and other frameworks used in this evaluation. It may be more efficient to combine

categories across frameworks. For example, CON program outcomes, Role Development includes “Partner with clients, families,

communities and interdisciplinary health care teams to design and provide quality health care” which aligns with QSEN’s Teamwork and

Collaboration. Similarly, CON program outcomes, Designer and Manager of Care includes “Use evolving information technology to

monitor and improve the health care of clients” which aligns with QSEN’s Informatics.

Table of QSEN competencies overlapping in other frameworks:

QSEN Competency Other Frameworks

Patient Centered Care

Teamwork and Collaboration CON (Role Development) AACN (#6)

Evidenced Based Practice AACN (#3)

Quality Improvement AACN (#2)

Safety AACN (#2)

Informatics CON (Designer and Manager of Care)

AACN (#4)

Recommendation: Integrate QSEN competencies into other frameworks in order to reduce the work of conducting this evaluation.

There is limited opportunity for interprofessional collaboration in education or practice.

Recommendation: incorporate more opportunities for interprofessional education and practice throughout the semester’s courses.

Quality Improvement and Informatics content were virtually nonexistent throughout the semester’s courses

Recommendation: systematically identify ways to increase QI and informatics throughout the curriculum.

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Conclusion

The members of Team Splendid Scholars would like to congratulate the faculty of the WSU School of Nursing for their courage to teach, and their

efforts to transform the curriculum. We recognize the enormity of the challenge, and sincerely hope that our project may facilitate the task. In a

recent publication, Tanner (1998) described the expectations set forth in the AACN Essentials as a "blueprint for the 21-year curriculum" (p. 383) but

also noted she believed none of the core knowledge and competencies identified could be eliminated (Giddens, 2007).

The author Emerson reminds us that “it is incumbent upon nursing education to provide theory and practice in the leadership, management and

managed care skills needed by the novice nurse”:

Students must develop enhanced leadership and management skills to respond to the managed care environment, practice skills that reflect

and respect the diversity of values and beliefs associated with an increasingly multicultural society, and citizenship skills of civic and social

responsibility to meet the needs of population aggregates (Emerson, 2007).

We have seen many of these elements successfully incorporated into the WSU nursing curricula. The ultimate challenge is to change the highly-

structured curricula to a focus on how to teach concepts instead of content. The members of Team Splendid Scholars agree that the WSU curriculum

is heavily laden in content. Superficial coverage of all topics in a subject area must be replaced with an in-depth coverage of fewer topics that allows

key concepts in the discipline to be understood (Tanner, 2007):

Rejecting the long-standing, content-loaded, behaviorist model of nursing education, revolutionaries called for a “caring” curriculum, creating

new pedagogies suited for a practice discipline in preparing students who could participate as leaders in health care reform, with values that

recognize the multicultural, multiracial, and growing diversity of both individual and family lifestyles in our society (Tanner, 2007).

In addition, this team suggests that a streamlined, perhaps electronic, method to gather curriculum assessments is developed. The challenge of

meeting multiple standards adequately over the course of a semester or curriculum is evident with this assignment. Faculty would benefit from an

assessment process that allows them to report what standards they are able to address in their courses, and a curriculum committee can be

responsible for assuring coordination so all standards are addressed. A survey tool at the end of each year or semester could prompt faculty to state

whether key standards were met or not. Faculty could describe how standards were met, and/or suggest ways to address any unmet standards. This

would further heighten awareness of faculty on the many standards the college is charged with addressing and engage creative solutions. Electronic

survey collection would allow for simplification of data analysis.

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Executive Summary:

An overview of the semester in its entirety suggest some priority areas where faculty might find opportunities to improve adherence to core

standards:

Diversity: All courses might increase opportunities to use simulation to address diversity, particularly if there are insufficient or inconsistent

clinical settings. Use outside speakers from diverse backgrounds for some topics.

EBP: Evidence-based practice seems to be inconsistently addressed. All courses should be challenged to assure their content is evidence-

based and reinforce that students consider research, clinical experience, and patient preferences to provide care that aligns with current triad models of an evidence-based practice.

Ethical Issues/History/Policy: These can be addressed in a project or discussion. Many policy decisions make history and derive from ethical

dilemmas. Evolution of nurse’s political involvement to create change (advanced practice status, IV sedation, ANA, unions versus non-union) and historical trends in patient care delivery models could be incorporated into assignments. Rather than try to be involved in policy

revision, provide case scenarios of examples where nurses have been involved in real life national and regional policy changing projects. One example is the work that was initiated by WOC nurses to convince HCFA to change the Medicare definition of debridement in the surgical

dressings section of the Medicare policy so that patients with chronic wounds could get reimbursement for wound dressings rather than pay out of pocket. The group then went on to recommend utilization parameters for the insurance groups that oversee implementation of Medicare (DMERC’s) and trained them on proper interpretation of required documentation. Projects that allow student nurses to learn about

political initiatives can do much to increase awareness about this professional role of the nurse.

Information Management: Information management seems to be an area identified as a “gap” in many courses. It is possible faculty do not

understand the definition of this standard, or they do not see its relevance in their courses. There may be opportunities to include greater appreciation for information management by addressing how nurses in all settings organize, retrieve, acquire and maintain information. In

addition, faculty might include data management in their lesson plans by asking students to retrieve data on the topic of interest from sites such as Centers for Disease Control, World Health Organization, or other collections of health data. To help meet multiple standards that are desired by AACN and other agencies, faculty might consider how each assignment can “multi-task” to meet several learning objectives; for

instance communication lessons can be within the context of inter-professional teams, varied populations, and on topics of safety or quality.

Evaluation of Care: This standard can be incorporated into existing lessons. Faculty can strive to incorporate patient outcomes, goals of care,

revising plan of care based on patient outcome, correlation with safety (from falls, UTI’s, SSI’s and pressure ulcers, for example) and discussion of “never events,” and use of root cause analysis.

Quality Improvement: Systematically identify ways to increase QI and informatics throughout the curriculum. These could be case scenario where student finds patient with a “never event” such as a fall, catheter associated UTI, or Stage 1 pressure ulcer and has to implement root cause analysis to identify triggering event and then make recommendations for change on the unit so potential for this to recur with another

patient is diminished.

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In addition, Team Splendid Scholars also agree that key elements nursing students need to be successful may be missing from the curriculum. Linda

Cronenwett’s The Future of Nursing Education (RWJ/IOM, 2011) provides a comprehensive list of what nursing students need to learn:

What Students Should Learn

1. Competencies necessary for continuous improvement of the quality and safety of health care systems

a. patient-centered care b. teamwork and collaboration c. evidence-based practice

d. quality improvement e. safety, and

f. informatics (Berwick, Cronenwett, Tanner) 2. Mastery of knowledge of systems

a. interpretations of variation

b. human psychology in complex systems, and c. approaches to gaining knowledge in real-world, local contexts (Berwick)

3. Skills and methods for leadership and management of continual improvement a. for nurse-teachers, and b. for nurse-executives (Berwick)

4. Competencies needed in new care delivery models 5. Population health and population-based care management (Tanner)

6. Care coordination (Tilden) 7. Knowledge based on standardized science prerequisites (Dracup, Tanner) 8. Health policy knowledge, skills, and attitudes (Tilden)

9. Competencies related to emerging health needs—e.g., geriatrics (Tanner) (RWJ/IOM, 2011)

Summary of Recommendations from "What to Teach" section:

1. Four realities driving changes in nursing education: (1) shift of care into community; (2)"evidence" not well integrated into practice or

education; (3) increased need for nurses to work in and lead teams, and (4) need additional research and new knowledge. 2. To enter practice of nursing, all students need: scientific background, practice based knowledge, clinical reasoning skills and ethical

comportment.

3. Rethink approaches to safety, patient-centered care, cultural competence and clinical judgment.

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o Motivating Themes:

1. Build in links among knowledge, practice and clinical reasoning skills 2. Think in terms of health care systems (beyond patient-nurse interactions)

o quality/safety issues

o team approaches to problem solving o need for patient education

o working across settings (seamless) o interdisciplinary team skills (able to lead effectively across settings and within groups) o collaboration and communication

3. Assess, use and "manage" knowledge so can access when needed o develop knowledge management, access and use of tools and strategies

o hardwire the ability to manage and use knowledge in real time in both education and practice 4. Care of older adults: geriatric syndromes, sleep disorders, dementia, delirium, depression, chronic care management. 5. Culturally sensitive and relationship centered care (inclusion, justice, diversity)

6. Educate for continuous improvement o competencies and skills to participate and lead CQI activities

o tools of CQI o use of informatics to enhance reliability of care o understand cultures of safety

7. Instill spirit of inquiry o examine evidence underlying practice

o access evidence o question underlying assumptions o offer new insights to improve quality of care

8. Refocus on the fundamentals to reflect expanded settings of care (may not be accomplished through subspecialties such as OB and peds).

Please accept our efforts on your behalf. We are grateful to have had this valuable learning opportunity.

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Works Cited

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Commission on Collegiate Nursing. (2009, April). Standards for Accreditation of Baccaluareate and Graduate Degree Nursing Programs .

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RWJ/IOM. (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from Committee on the RWJ Foundation Initiative on the

Future of Nursing at the Institute of Medicine:

http://www.iom.edu/~/media/Files/Activity%20Files/Workforce/Nursing/Future%20of%20Nursing%20Education.pdf

Tanner, C. (2007). The curriculum revolution revisited. Journal of Nursing Education Feb (46) 2, 51-52.

U.S. Department of Health & Human Services. (2006, March). Pay for Performance (P4P): AHRQ Resources. Retrieved from Agency for

Healthcare Research & Quality: http://www.ahrq.gov/qual/pay4per.htm

Whittington, O. &. (2004). Principles of Auditing and Other Assurance Services (14th edition ed.). New York: McGraw-Hill/Irwin.

Documents

N523 Gap Analysis