Innovation in Care Delivery: Advancing a Professional Practice Environment

Dedicated Education Units:
Strengthening a Lea...
Overview
 History of the Dedicated Education Process
 Initial Implementation at MGH
 The Interprofessional Dedicated Ed...
Why Clinical Education Must
 Obstacles to achieving quality clinical education experiences have
Change
been reported.

 ...
Visit by Kay Edgecombe, Flinders University
So. Adelaide, Australia September 2010
The History

blog.questia.com

 Edgecombe’s DEU model for
nursing clinical education
represents a dramatic shift in
focus...
Clinical Education
 Shared Vision and Goals
Partnerships
 Quality Education and Innovative Practice
 Nursing Faculty an...
A Partnership: University of
Massachusetts Boston, Massachusetts
General Hospital, and Brigham and
Women’s Hospital
A mo...
Dedicated Education Unit
is….

 An innovative model of clinical nursing education.
An entire patient care unit is transf...
Defining the Roles of the DEU
Model

CI = Clinical Instructor. A BS prepared staff nurse
with five years of clinical exper...
Features of the DEU
 Exclusive use of the DEU by University of
Massachusetts Boston students.
 Staff nurses would serve ...
DEU IMPLEMENTATION
TIMELINE
Jan 2008 Began Two DEUs
Jan 2008 Began Two DEUs
Pilot Study focused on
Pilot Study focused on
...
Overarching Research
Question
“How does the DEU intervention develop new instructors

(thus building capacity), enhance fa...
STUDY
DESIGN

UMB CNHS Juniors, Good
Academic Standing

XOXOX
OXOXO
XOXOX
OXOXO







14 Week
Semesters
4 Cohorts
(Stu...
Data Collection Processes
SAMPLE DETAILS

Students n = 162
4 Semester Cohorts 2010-2012
RESULTS

Comparison of Educational Quality:
DEU vs Traditional Students (Mean Scores)
P < .001 SECEE; P < .01 GCL; QSEN
P ...
RESULTS

Comparison of QSEN Competency Development:
DEU vs Traditional Students (Mean Scores)
P<.001 QI, Informatics, Team...
DEU Students Spend More Time on
Time spent on instruction (2x) compared to other activities, by group
Instruction
remainde...
CONCLUSION
S

 DEU clinical education model is as effective as traditional model.
Exceeds students’ perception of clinica...
WORK LIFE:
CIs report benefits
from working with
students
WORK LIFE

DEU CIs Exhibit Enhanced
Spirit of Inquiry and Motivation
“So I think it has helped me realize that there is so...
DEU Student
Presentation:
Learning Styles
of the Next
Generation
DEU Cycle
of
Sustainabil
ity
Program Growth
(per semester)
 2008 (Spring): 12 junior students
 2009: 16 juniors, 12 seniors
 2010: 30 juniors,12 -16...
Recruitment
2008 – 2012
PCA – 31
RN – 16
Orientation Savings
PCA

Traditional
DEU student

3 - 4 weeks
1.5 weeks

RN

Traditional
DEU student

8 -12 weeks
6 - 8 we...
Professional
Development
ASN – BSN Enrollment

4 Staff Nurses have enrolled in BSN completion
program within the last two ...
Recommendations for Further
Study
Deeper dive into:
Unit sustainability
 (mix of staff, rotation patterns, CI retention,...
Interprofessional Dedicated
Education Unit Experience at MGH
Carmen Vega-Barachowitz, MS, CCC-SLP
Director MGH Speech, Lan...
Overview
The purpose of this part of the presentation is to:
Discuss current evidence indicating that interprofessional
c...
Introduction

Healthcare Reform:

A great moment to re-examine interprofessional
approaches with the goal of addressing:
...
Evidence to Support
Interprofessional Education
 System is fragmented, silo-filled and more discipline-centric than
patie...
Quality & Safety
Implications

 Decreased medical errors and near misses:
 attributed to IP communication

 by increasi...
JC Sentinel Events
Context Patient Safety Concerns
Root Causes of Sentinel Events (all categories, 1995 –
2005)

We need t...
Strong Collaboration Leading to Better
Outcomes
Association Between
Nurse-Physician
Collaboration
and Negative Patient
Out...
Interprofessional
Collaboration
Interprofessional Education
 Interprofessional Collaboration is a patient-centered
approa...
Background:
IPE as precursor of IPC
 Create a coordinated effort across health professions
 Guide professionals and inst...
 A process which includes but is not limited to
communication and decision-making
 Collaborative practice includes:
 Re...
Framework
for Action:
Interprofessio
nal education
and
collaborative
practice
World Health Organization. 2010. Framework f...
Goal:

Interprofessional Collaborative Practice
as the key to safe, high-quality,
accessible patient-centered care
Sponsor...
Goal:

Interprofessional Collaborative Practice
as the key to safe, high-quality,
accessible patient-centered care
IP Comp...
IPDEU Background
Collaboration between
Massachusetts General Hospital &
MGH Institute of Health Professions
Model & disciplines involved
Model of DEU for nursing
4. DEU students
are hired as RNs
on DEU units,
Supporting the
DEU mo...
MGH staff in clinical educator
(PT) role or senior staff (SLP)
is a mentor and coach to
less experienced
clinical supervis...
Patient Centered
Care

Interprofessio
nal Education:
IP-DEU

Interprofessional
Clinical Education
Clinical interaction;
De...
IPDEU Goals &
Objectives that has
 Deliver effective interprofessional clinical education





potential to lead to e...
Clinical
Day
Structure
Interprofessional Dedicated
Education Units
Clinical Site: Massachusetts General Hospital
Ellison 8: 36-bed in-patient Ca...
The Students

 Twenty-four students from CSD, Nursing, PT are
placed into mixed discipline pairs (dyads) per
semester
 N...
The Faculty
Clinical Faculty Coordinators MGH IHP
Clinical Instructors RNs, PTs, SLPs
CI Staff Educators PT & SLP
CI t...
The Clinical Day
 Each student does clinical preparation prior to
clinical day
 Dyads present prep to each other as well...
Engaging Students Across
Disciplines
Communication

Balance/Fall Prevention

Interdisciplinary Rounds

Vital Signs/Physiol...
Debriefings &
Reflective
Component

Weekly Debriefings
 Common themes within the
objectives are discussed; facilitates
s...
Evaluation Plan
Case based analysis of student experiences
Evaluation plan awaiting IRB approval
Generation of addition...
Qualitative Comments
 Able to communicate to patient with more knowledge
and expertise
 Improved understanding of patien...
Qualitative Comments
 All of the disciplines blend in a way that supports patient
care and the patient would not receive ...
Future
Directions/Considerations

 Involvement of other disciplines including medical
learners
 Expansion of the IPDEUs ...
Dedicated Education Units: Strengthening a Learning Culture
Upcoming SlideShare
Loading in...5
×

Dedicated Education Units: Strengthening a Learning Culture

645

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
645
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • DEU Video:
    http://www.youtube.com/watch?v=cvfDh0ep_zo
  • Blue Ribbon Pane; for Future of Ns Edu Research and Think Tank on Trasnfoming CNE i/d’d 3 major areas of focus for future research in NE: new models of CNE fostering relationships betw school and agencies that ALIGN cliical learning w contempr practice and hc needs
    What Constitutes Clinical Education as well as relationship bet instructinoal approach used and students’ abilities to practice not definitively documented.
    LACK of EVIDENCE to support pedagogical decision abou clinical educ
    However, succinctly defining clinical education quality with an established set of process and outcome indicators remains elusive.
  • Coordination v Cooperation
    Coop- no formal rules, each instit has indep goals, no vertical or horizontal linkages few personnel resources and little threat to autonomy for either organ.
    Contrast Corporat Coordination: a foraml agreement bet both parties based on joint goals and activities acchieved via mechanisms external to members’ personal relationships We had formal CP agreements, however not on these particular units. Deemed Innovation Units by both CNOs ND agreement WE did come together and drew up a tacit agreement- Our Tenets of Understanding- brings reasonable level of fidelity to the Innovation
    Partnership building takes time
    Strong relationships between academia and service
    (Deans, Chairs, CNOs, Education/Prof.Devt./QI,
    Directors, Faculty, Staff, and Students)
    Commitment, contact , communication
    Resource allocation required
    Benefits in collaboration at all levels
  • Results of Pilot Study are The pilot phase evaluation dem- onstrates the DeU clinical education model clearly facilitated teaching and learning of quality and safety compe- tencies. in addition, the education- practice partnership, initially created to implement the clinical education delivery model, was strengthened as a result of performing this prelimi- nary evaluation. Focus gps led to PCA and stipends and providing grad courses
    A common early theme was articulated as “Were they actually ‘teaching’ enough? And “Were they were holding the students to high enough standards?” With continual role development the confidence of these skilled practitioners has grown and the expectations of the students have also increased. The eighteen students involved reported a sense of accomplishment and some have expressed amazement at how much they had learned thus far by mid-semester. Overall, the first half of the semester of this pilot program has been evaluated as a positive experience for all involved.
  • The purpose of the formal evaluation study under a controlled design was to examine the innovation’s effectiveness, efficiency, and ability to build capacity. An overarching question to be addressed by the evaluation is, “How does the DEU intervention support the development of new instructors, thus building capacity, enhancing faculty worklife, and sustaining recruitment, retention, and productivity?” Specific statements germane to our thinking include:
    If staff nurses are provided with specific orientation by Clinical Faculty Coordinators (CFC) and unit support, then they can be recruited and function as new DEU instructors.
    If staff nurses are provided with ongoing support by CFC and unit, then they will be satisfied as new DEU clinical instructors (CI), and then other staff may become interested and recruited as new CIs.
    If staff nurses are provided with modest incentives (stipend), then they will be retained and sustained as CIs, and they will advance on their units (ladder/productivity).
    If staff nurses as DEU CIs are provided with incentives (voucher) then they will return for advanced education.
    If staff nurses are utilized as clinical instructors, then college faculty can shift roles and take on new responsibilities, and then be satisfied and produce in new ways, and then be retained. (satisfaction/productivity/retention).
    If staff nurses are utilized as clinical instructors, then college clinical instructors can be utilized as instructors in new placements with enrollments of new students in new program (accelerated option) and/or existing program expansion(capacity)
    If the task force provides dedicated support and oversight, then the innovation can be productive, sustained, and replicated.
  • Internal Validity:
    RCT (causality, selection)
    Two threats: Hawthorne,
    attrition
    Replication
    Triangulation of data and
    methods
    External Validity:
    Subjects are typical
    nursing students
    Are sites/people typical?
  • Student Evaluation of Clinical Education Experience (SECEE) inventory was used to measure student perceptions of clinical instruction and clinical learning opportunities (Sand-Jecklin, 2009).
  • Original Response Scale: Growth in Clinical Learning A great deal of growth=5 to No growth=1
  • Remainder time Pt Care
  • Opportunities for Professional Growth .05 level signif
  • Hourly RoundingAlternatives to Restraints
    Pressure Ulcer Prevention Presentation
    GRANd ROUNDS
    Fall Prevention
    Enhancing CAPD Procedures
    Quiet Hours
    Post op Pressure Sore Prevention
  • Unit is the driver for sustainability – Academic-Practice Partnership is key
    Cycle of Sustainability:
    More nurses are educated over time (incentives)
    DEUs can mentor growth of new DEUs
    Students benefit from quality clinical education
    DEU students are hired on unit as new RNS
    Staff Nurses become CIs
    CIs become more skilled in clinical instruction with CFC coaching
    Students, nurses, the nursing unit and educational program benefit
    DEU students are hired as RNs on DEU units, supporting the DEU model; nurses return for advanced degrees
  • With changes in the healthcare system including the ACC (Supreme court ruling June 28, 2012), rising costs and increased focus on Q&amp;S, efficiency, effectiveness and pt centeredness, this is the perfect time to re-examine how health care professionals are educated, not only within their profession but also as members of interprofessional teams.
    Accountable care organization, value based purchasing. Linking quality to costs
  • Executive Summary: Terry Fulmer, RN, PhD, FAAN June 28, 2012
    Keeping pace with the changes in healthcare
    Mismatch of competencies for needs: EXAMPLE
    “When I was in medical school I spent hundreds of hours looking into a microscope – a skill I never needed to know or ever use. Yet, I didn’t have a single class that taught me communication and teamwork skills – something I need every day I walk into the hospital.” (Pronovost &amp; Vohr, 2010, p 46) IPEC 2011, p.22
    In Washington last week discussing curricular desing. More evidence is needed about what are the best models of education for all disciplines.
  • The four competencies focus on knowing not only your own professional role, ethics, responsibility etc, but also other professions. “Knowing” makes the communication process clearer, including clarifying communications received from others.
    Standardized language SBAR– Situation, Background, Assessment and Recommendation
  • Sentinel events are unanticipated events in health care resulting in death or serious injury, physical or psychological
  • Interprofessional Education is Defined as: “Members or students of two or more professions associated with health or social care, engaged in learning with, from and around each other”
    Provides ability to share knowledge and skill set between professions and allows for a better understanding of the healthcare process
    Desired outcome is to develop an interprofessional team-based, collaborative approach that will improve patient outcomes and quality of care while hospitalized.
  • Collaboration between MGH/IHP
    Academic Practice Partnerships
  • Team Based care
    Care coordination
    Mutual trust and respect, and understanding other disciplines
  • Source: WHO, p. 9, 2010 (Geneva). IPEC p. 16.
    Think locally – dose of team
    Focus on collaborative practice
    The WHO Framework highlights curricular and educator mechanisms that help interprofessional education succeed, as well as institutional support, working culture, and environmental elements that drive collaborative practice. The framework incorporates actions that leaders and policymakers can take to bolster interprofessional education and interprofessional collaborative practice for the improvement of health care. At the national level, positive health professions education and health systems actions are pointed to that could synergistically drive more integrated health workforce planning and policymaking.
    In order to advance this agenda, the Health Resources and Services Administration (HRSA) just awarded a 4 million dollar grant to University of Minnesota Academic Health Center to provide national leadership in the filed of Interprofessional education and collaboration
  • IPEC:
    Interest in promoting more team-based education for US health professions is not new. At the first IOM Conference, “Interrelationships of Educational Programs for Health Professionals,” and in the related report “Educating for the Health Team” (IOM, 1972), 120 leaders from allied health, dentistry, medicine, nursing, and pharmacy considered key questions at the forefront of contemporary national discussions about interprofessional education.
    Core Competencies published May 2011, sponsored by IPEC (Interprofessional education collaborative)
    Report of an Expert Panel: May 2011
  • Values/ethics : Background / Rationale: Values &amp; ethics are considered an element of professionalism, which has significant overlap with constructs of humanism and morality (Baldwin, 2006). These values become a core part of professional identity. Dombeck (1997) has labeled the moral agency associated with that identity as “professional personhood.” Gen Competency Statement-VE. Work with individuals of other professions to maintain a climate of mutual respect and shared values.
    Roles/Responsibilities: Background / Rationale: “Front line” health professionals identify being able to clearly describe one’s own professional role &amp; responsibilities to team members of other professions &amp; understand others’ roles &amp; responsibilities in relation to one’s own role as a core competency for collaborative practice. GCS-RR. Use the knowledge of one’s own role &amp; those of other professions to appropriately assess &amp; address the healthcare needs of the patients &amp; populations served.
    IP Communication: Background / Rationale: Communication competencies help professionals prepare for collaborative practice. One of the five IOM core competencies (IOM, 2003) is the ability to use informatics. GCS-CC. Communicate with patients, families, communities, &amp; other health professionals in a responsive, responsible manner that supports a team approach to the maintenance of health &amp; the treatment of disease.
    Teams / Teamwork: Background/Rationale: Learning to be interprofessional means learning to be a good team player. GCS-TT. Apply relationship-building values &amp; the principles of team dynamics to perform effectively in different team roles to plan &amp; deliver patient/population-centered care that is safe, timely, efficient, effective &amp; equitable.
  • 3 Tiers:
    Jointly conceived by leadership
    Support from patient care unit leadership and clinical department managers
    Model and process developed by clinical education faculty from both institutions
    Clinical and Academic Partnership
  • Model:
    - unit staff nurses selected as CIs (minimum BSN, 5 yrs experience)
    - Clinical Faculty Coordinator (CFC), an MGH IHP School of Nursing faculty member, serves as the iaison between the MGH IHP and MGH.
    - The CFC supports the staff nurses in their development as CIs
    - the CFC conducts initial workshops, orients CIs to MGHIHP, introduces concept of IP-DEU, learning objectives for each of the programs, course objectives, the IPEC competencies, principles of adult learning and student evaluation
    - one CI is responsible for working with one student dyad, each including one nursing student and one SLP or PT, throughout a clinical semester.
    - Multiple dyads are providing care on the clinical unit at any given time
    - The CIs facilitate multiple dyad participation in interprofessional rounds and in clinical conferences
    - this assures that all students are exposed to perspectives from each of the 3 professions
    Overarching objectives:
    Nursing/PT/SLP students&apos; achievement of the IPEC Core Competencies for Interprofessioanl Collaborative Practice
    2. Safe, effective patient care through use of high functioning collaborative interprofessional health care teams
    3. Commitment to life long learning through active collaboration in the educational process
  • Visual representation of the IP-DEU model.
    The patient is the center nucleus of the model. A mixed discipline dyad pair cares for their patient throughout the clinical day and interfaces with the CIs from the program disciplines as they work with the patient. A strength of this model is in the dyad remaining with the patient throughout consults and nursing assessments the students are able to understand the patient’s story.
    What is not represented in this picture in the academic support provided to the unit via the CFCs in this case an IP faculty group that are regularly present on the unit to mentor both students and clinical staff. The 3 of us here today are the CFCs for the IP-DEU program.
    Communication amongst the 3 of us and the entire team is instrumental in the success of this program.
  • -
    Ideally our goal will be to have all students working on one clinical day.
    -Each dyad spends two weeks with each other, Nsg/PT, Nsg/SLP, and CSD/PT and then rotate through so each have an opportunity to learn from each other
    Nursing/Physical Therapy/Speech-Language Pathology
    Nursing, PT &amp; SLP staff as clinical instructors
    IP dyads
    MGH IHP faculty and MGH Senior staff in Nursing, PT, SLP provide support and coaching for CIs
  • RN: Second semester of their first year.
    Will be last medical/surgical clinical
    Last semester they did not pass medications, this semester they will be passing medications.
    PT: Second or third semester of their first year.
    Gross Anatomy and Professional Socialization coursework completed.
    Limited to no experience in the inpatient setting.
    Beginning pharmacology coursework.
    SLP: First or second semester of their second year.
    They have an active interest in medical speech pathology.
    They have had no formal introduction to pharmacology or pathophysiology.
    They have had a clinical but not in the medical setting.
  • Methods: four phases
    Phase 1: ethnography, participant observers. Traditional ethnography – data collected via field notes which will be coded and analyzed by the research team on an ongoing basis. An ethnography consultant will provide independent analysis of selected data to strengthen findings.
    Phase 2: Nature of student experience, participant observers. Use IPEC competencies as a lens for coding and analysis – theory guided ethnography (Bernard, 2002). Supplement with student interviews
    Phase 3: begin with a crosswalk of the IPEC competencies with the data from phases 1&amp;2 to produce an inventory of the competencies required by faculty and clinical staff to teach in an interprofessional clinical environment.
    Phase 4: development and testing of an empirically based instrument to assess student achievement of specific milestones in the achievement of the IPEC competencies.
    Research questions:
    What is the nature of the student experience and in particular interprofessional student interaction between nursing students and students from the rehabilitation disciplines (PT &amp; SLP) on the IPDEU?
    What are objective milestones of achievement of the IPEC competencies in real world clinical experiences?
    What are the competencies required of both clinical instructors and clinical faculty coordinators for teaching/learning on the IPDEU?
    What is the impact of the IPDEU model on faculty productivity and satisfaction?
    IRB:
  • Do you have comments for this slide?
    ?? Something from the CFCs?
  • Dedicated Education Units: Strengthening a Learning Culture

    1. 1. Innovation in Care Delivery: Advancing a Professional Practice Environment Dedicated Education Units: Strengthening a Learning Culture
    2. 2. Overview  History of the Dedicated Education Process  Initial Implementation at MGH  The Interprofessional Dedicated Education Unit Experience at MGH
    3. 3. Why Clinical Education Must  Obstacles to achieving quality clinical education experiences have Change been reported.  Recommendations to optimize clinical learning have been articulated:  Align learning and engagement in clinical practice realities  Focus on achievement of students’ clinical learning goals  Address quality and safety improvement  Develop clinical reasoning and a spirit of inquiry (Ard & Valiga, 2009; Benner, Sutphen, Leonard, & Day, 2010, IOM-Future of Nursing Report, 2011; Ironside & McNelis 2010; NLN Think Tank of Transforming Clinical Education, 2008; NLN National Survey, 2009)
    4. 4. Visit by Kay Edgecombe, Flinders University So. Adelaide, Australia September 2010
    5. 5. The History blog.questia.com  Edgecombe’s DEU model for nursing clinical education represents a dramatic shift in focus on staff nurses assuming the clinical instructor responsibilities for individual students per semester, as well as the entire clinical unit and all staff focused on student learning and immersion into the clinical setting.
    6. 6. Clinical Education  Shared Vision and Goals Partnerships  Quality Education and Innovative Practice  Nursing Faculty and RN Shortages  Diverse Workforce  Patient Care Unit Development  Professional Nurse Formation  Quality & Safety Competencies  Continuous Improvement  Coordination and Relationship-building Processes
    7. 7. A Partnership: University of Massachusetts Boston, Massachusetts General Hospital, and Brigham and Women’s Hospital A model where nursing practice informs nursing education and nursing education influences nursing practice
    8. 8. Dedicated Education Unit is….  An innovative model of clinical nursing education. An entire patient care unit is transformed into an optimal teaching/learning environment. The DEU model strives to address the mechanisms that help alleviate the faculty shortage while providing enhanced nursing education and improving practice.
    9. 9. Defining the Roles of the DEU Model CI = Clinical Instructor. A BS prepared staff nurse with five years of clinical experience is granted an adjunct faculty appointment at UMASS Boston. The staff provides direct clinical instruction, supervision, and evaluation of two nursing students. CFC = Clinical Faculty Coordinator. A course professor at UMass Boston who collaborates with nursing management to support the CIs in their education and evaluation of the students.
    10. 10. Features of the DEU  Exclusive use of the DEU by University of Massachusetts Boston students.  Staff nurses would serve as clinical Instructors for two nursing students over the course of the semester.  Orientation and faculty enrichment days provided to the CIs by the College of Nursing.  University faculty expertise to support the CIs.  Commitment by all parties to build an optimal learning environment.
    11. 11. DEU IMPLEMENTATION TIMELINE Jan 2008 Began Two DEUs Jan 2008 Began Two DEUs Pilot Study focused on Pilot Study focused on Quality/Safety competency Quality/Safety competency development, Staff Nurse development, Staff Nurse Satisfaction RWJF Grant Satisfaction RWJF Grant QSEN Phase Two, Project QSEN Phase Two, Project School School 2006 UMass Boston with UMass Boston with MGH and BWH of MGH and BWH of Partners HealthCare Partners HealthCare Partnership formed Partnership formed 2007 Additional DEU Additional DEU Study site began Study site began Good Samaritan Good Samaritan Medical Center, Medical Center, Brockton, MA Brockton, MA Steward Health Steward Health Systems Systems 2010 2011 RWJF Grant (Jan 2010) RWJF Grant (Jan 2010) Evaluating Innovations in Evaluating Innovations in Nursing Education Program Nursing Education Program Project PDQ Project PDQ First randomized control DEU First randomized control DEU study, Expanded number of study, Expanded number of 2012 Two Two -year -year EIN EIN Study Study complete complete d d
    12. 12. Overarching Research Question “How does the DEU intervention develop new instructors (thus building capacity), enhance faculty work-life (thus sustaining recruitment, retention, and productivity), and promote educational quality, functioning within a shared DEU partnership structure and within local contexts, amidst nursing unit similarities and differences?”
    13. 13. STUDY DESIGN UMB CNHS Juniors, Good Academic Standing XOXOX OXOXO XOXOX OXOXO    14 Week Semesters 4 Cohorts (Students) Surveys, Junior Year: NU310 Control 8:1 Senior Year: NU455 Control 1:1 4 Clinical Rotations Random Assignment DEU 2:1 DEU 1-2:1 Clinical Instructors: Provide clinical instruction to students CFCs: Coach CIs and provide clinical instruction guidance CNHS Faculty: Provide classroom-based instruction; Colleagues with CFCs in academic service partnership
    14. 14. Data Collection Processes
    15. 15. SAMPLE DETAILS Students n = 162 4 Semester Cohorts 2010-2012
    16. 16. RESULTS Comparison of Educational Quality: DEU vs Traditional Students (Mean Scores) P < .001 SECEE; P < .01 GCL; QSEN P < .001 SECEE; P < .01 GCL; QSEN
    17. 17. RESULTS Comparison of QSEN Competency Development: DEU vs Traditional Students (Mean Scores) P<.001 QI, Informatics, Teamwork P<.001 QI, Informatics, Teamwork
    18. 18. DEU Students Spend More Time on Time spent on instruction (2x) compared to other activities, by group Instruction remainder: same time spent on patient care/management of care activities
    19. 19. CONCLUSION S  DEU clinical education model is as effective as traditional model. Exceeds students’ perception of clinical learning in almost all items. Clinical learning is optimized.  DEU model provides more clinical learning opportunities and focus on QSEN competency development.  DEUs provided similar total direct patient care time; however, DEU students reported more instructional time, especially during patient care  Opportunity for teamwork experiences exceeded those available in the traditional model.
    20. 20. WORK LIFE: CIs report benefits from working with students
    21. 21. WORK LIFE DEU CIs Exhibit Enhanced Spirit of Inquiry and Motivation “So I think it has helped me realize that there is so much still to learn. It keeps you fresh. You keep going back to your basics, you know. Because you kind of get lost in the fact that you’ve been doing this for so long that it becomes old hat to you…” “It keeps me up to date with my knowledge. I feel like, you know, you’re kind of molding the brains of new nurses. It makes you learn about yourself, how you learn, positives and negatives.”
    22. 22. DEU Student Presentation: Learning Styles of the Next Generation
    23. 23. DEU Cycle of Sustainabil ity
    24. 24. Program Growth (per semester)  2008 (Spring): 12 junior students  2009: 16 juniors, 12 seniors  2010: 30 juniors,12 -16 seniors *additional DEU unit started  2011: 24 - 28 juniors, 16 - 28 Seniors  2012: 20 juniors,16 - 28 Seniors
    25. 25. Recruitment 2008 – 2012 PCA – 31 RN – 16
    26. 26. Orientation Savings PCA Traditional DEU student 3 - 4 weeks 1.5 weeks RN Traditional DEU student 8 -12 weeks 6 - 8 weeks
    27. 27. Professional Development ASN – BSN Enrollment 4 Staff Nurses have enrolled in BSN completion program within the last two years. BSN – Masters 4 Staff Nurses have enrolled in Masters program within the last two years. Masters-level Enrollment 8 -12 vouchers per year utilized by DEU staff
    28. 28. Recommendations for Further Study Deeper dive into: Unit sustainability  (mix of staff, rotation patterns, CI retention, max./min. student numbers.) Student performance CI development and CFC coaching Transition to practice
    29. 29. Interprofessional Dedicated Education Unit Experience at MGH Carmen Vega-Barachowitz, MS, CCC-SLP Director MGH Speech, Language & Swallowing Disorders IPDEU Member Steering Committee & IPDEU Faculty
    30. 30. Overview The purpose of this part of the presentation is to: Discuss current evidence indicating that interprofessional collaborative practice are essential to safe, high quality, patient-centered care Discuss the rationale for interprofessional education as precursor to interprofessional collaborative practice Discuss the Interprofessional Dedicated Education Unit (IPDEU) including the evolution, structure and outcomes evaluation
    31. 31. Introduction Healthcare Reform: A great moment to re-examine interprofessional approaches with the goal of addressing: Quality Safety Efficiency Effectiveness Patient Centeredness
    32. 32. Evidence to Support Interprofessional Education  System is fragmented, silo-filled and more discipline-centric than patient-centered  Incidence of medical errors; 66% attributed to interprofessional communication breakdown  Coordination across complex systems, especially with multiple comorbidities, requires expert collaboration across all members of the team.  Traditional HP education still occurs in silos; exposure to other disciplines is random and not purposeful
    33. 33. Quality & Safety Implications  Decreased medical errors and near misses:  attributed to IP communication  by increasing comfort with direct communication through standardized language  by improving understanding of roles, responsibilities and the abilities of team members
    34. 34. JC Sentinel Events Context Patient Safety Concerns Root Causes of Sentinel Events (all categories, 1995 – 2005) We need to foster better communication between healthcare professionals as an approach to improving patient safety Percent of 3548 events
    35. 35. Strong Collaboration Leading to Better Outcomes Association Between Nurse-Physician Collaboration and Negative Patient Outcomes in ICU The higher the level of The higher the level of nurse-physician nurse-physician collaboration, the lower collaboration, the lower the risk of a negative the risk of a negative patient outcome patient outcome Med-Surg Surgical ICU Medical ICU Source: Definitions.net, STANDS4 LLC, 2012. http://www.definitions.net/definition/communication, accessed January 17, 2012; Fagin CM, Collaboration Between Nurses and Physicians: No Longer a Choice, Academic Medicine, 1992; 67(5):295-303; Baggs, et al., “Association Between Nurse-Physician Collaboration and Patient Outcomes in Three Intensive Care Units,” Critical Care Medicine, 1999, 27(9):1991-1998.
    36. 36. Interprofessional Collaboration Interprofessional Education  Interprofessional Collaboration is a patient-centered approach to health care delivery that synergistically maximizes the strengths and skills of each contributing health worker to optimize the quality of patient care.  Interprofessional Education occurs when learners from two or more professions learn with, from and about each other to enable effective collaboration and improve health outcomes.
    37. 37. Background: IPE as precursor of IPC  Create a coordinated effort across health professions  Guide professionals and institutional curricular development of learning approaches & strategies  Provide a dialogue to evaluate the fit between education and practice demands  Provide a foundation for a learning continuum in IPC for lifelong learning
    38. 38.  A process which includes but is not limited to communication and decision-making  Collaborative practice includes:  Responsibility  Accountability  Coordination  Communication  Cooperation  Assertiveness  Autonomy  Mutual trust and respect Interprofessional Collaboration Interprofessional Education
    39. 39. Framework for Action: Interprofessio nal education and collaborative practice World Health Organization. 2010. Framework for Action on Interprofessional Education & Collaborative Practice. WHO, Geneva. p. 9
    40. 40. Goal: Interprofessional Collaborative Practice as the key to safe, high-quality, accessible patient-centered care Sponsors  American Association of Colleges of Pharmacy  American Association of Colleges of Nursing  American Association of Colleges of Osteopathic Medicine  American Dental Education Association  Association of Schools of Public Health  Association of American Medical Colleges
    41. 41. Goal: Interprofessional Collaborative Practice as the key to safe, high-quality, accessible patient-centered care IP Competency Domains A generally identified cluster of more specific interprofessional competencies that are conceptually linked, and serve as theoretical constructs. Values/ethics for IP Practice Roles/Responsibilities IP Communication Teams and Teamwork
    42. 42. IPDEU Background Collaboration between Massachusetts General Hospital & MGH Institute of Health Professions
    43. 43. Model & disciplines involved Model of DEU for nursing 4. DEU students are hired as RNs on DEU units, Supporting the DEU model: RNs return for advanced degrees. 1. Staff nurses become CIs SED TWICE e version on slide 23) 3. Students, nurses, the nursing unit and educational unit benefit. 2. CIs become more skilled in clinical instruction with CFC coaching.
    44. 44. MGH staff in clinical educator (PT) role or senior staff (SLP) is a mentor and coach to less experienced clinical supervisors Physical Therapy & SLP Model MGH Experienced Clinician becomes clinical supervisor 1:1 discipline specific clinical education at the bedside or ambulatory setting
    45. 45. Patient Centered Care Interprofessio nal Education: IP-DEU Interprofessional Clinical Education Clinical interaction; Debriefings, Seminars Interprofessional Collaboration: Team partnership Communication Coordination Understanding of roles
    46. 46. IPDEU Goals & Objectives that has  Deliver effective interprofessional clinical education     potential to lead to effective interprofessional collaborative practice and improved patient outcomes Integrate both professional and interprofessional activities and competencies in the clinical experience Generate interest in practicing in the acute care environment Offer professional development opportunities for clinical instructors Increase the understanding of discipline specific contributions leading to appropriate consults and referrals
    47. 47. Clinical Day Structure
    48. 48. Interprofessional Dedicated Education Units Clinical Site: Massachusetts General Hospital Ellison 8: 36-bed in-patient Cardiac Stepdown unit Bigelow 11: 24-bed General Medicine unit
    49. 49. The Students  Twenty-four students from CSD, Nursing, PT are placed into mixed discipline pairs (dyads) per semester  Nursing students are in the Accelerated BSN program or Direct Entry Nursing (DEN) program  Physical therapy students are in the Doctor of Physical Therapy program  Communication Science and Disorders students are in the Masters of Science in Speech and Language Pathology program.
    50. 50. The Faculty Clinical Faculty Coordinators MGH IHP Clinical Instructors RNs, PTs, SLPs CI Staff Educators PT & SLP CI training Teaching across disciplines One hour simulated session mandatory for all clinical instructors
    51. 51. The Clinical Day  Each student does clinical preparation prior to clinical day  Dyads present prep to each other as well as nursing CI on the morning of clinical- allows for awareness of varied approaches of chart review as well as importance of roles
    52. 52. Engaging Students Across Disciplines Communication Balance/Fall Prevention Interdisciplinary Rounds Vital Signs/Physiologic Response Edema Management Activity Instruction/Sternal Precautions Medications Endurance PATIENT & FAMILY CENTRIC CARE Integument Cognition Patient & Family Positioning Swallowing Ethical Issues Consultations Patient & Family Education Medical Management Ventilation/Gas Exchange
    53. 53. Debriefings & Reflective Component Weekly Debriefings  Common themes within the objectives are discussed; facilitates self reflection and critical thinking Bi-monthly Reflections  Reflections read by coordinators, comments provided Final Seminar “Interprofessional Rounds”  Held at the end to demonstrate growth of the student, as well as awareness of value of other team members
    54. 54. Evaluation Plan Case based analysis of student experiences Evaluation plan awaiting IRB approval Generation of additional research questions
    55. 55. Qualitative Comments  Able to communicate to patient with more knowledge and expertise  Improved understanding of patient because they understand team members and their roles  Having dyad partner and primary CI allows for creation of ‘safety net’ where they can ask questions, receive feedback, non threatening environment  Seeing things from a different perspective forced you to think about the patient and how they are affected
    56. 56. Qualitative Comments  All of the disciplines blend in a way that supports patient care and the patient would not receive the best care if it weren’t for the interprofessional practice.  I have a better understanding of what my role is with PT and SLP  I think the debriefing sessions were…influential. It was great having all of the disciplines present and hearing their perspectives and contributions to difficult problems.
    57. 57. Future Directions/Considerations  Involvement of other disciplines including medical learners  Expansion of the IPDEUs beyond the current two clinical units; the model may need to be adapted  Assess impact of this model to patient outcomes  Longitudinal implications on interprofessional practice
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×