- Email: [email protected]
A new model in teaching undergraduate research: A collaborative approach and learning cooperatives
Accepted Manuscript A new model in teaching undergraduate research: A collaborative approach and learning cooperatives Pamela V. O’Neal, Judith M. Jarosinski PII:
S1471-5953(16)30010-5
DOI:
10.1016/j.nepr.2016.03.008
Reference:
YNEPR 2104
To appear in:
Nurse Education in Practice
Received Date: 16 September 2014 Revised Date:
2 February 2016
Accepted Date: 25 March 2016
Please cite this article as: O’Neal, P.V., Jarosinski, J.M., A new model in teaching undergraduate research: A collaborative approach and learning cooperatives, Nurse Education in Practice (2016), doi: 10.1016/j.nepr.2016.03.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title Page Title:
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A NEW MODEL IN TEACHING UNDERGRADUATE RESEARCH: A COLLABORATIVE APPROACH AND LEARNING COOPERATIVES
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First and Corresponding Author: Pamela V. O’Neal, Associate Professor University of Alabama in Huntsville College of Nursing 301 Sparkman Drive Huntsville, Alabama 35811 USA Email: [email protected] Phone: international dialing prefix 011 and national dialing prefix+1 and phone number 256.426.8275
Word count: 1,777
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Second Author: Judith M. Jarosinski, Associate Professor Salisbury University, Department of Nursing, Salisbury, MD USA Email: [email protected] Phone: +011256.910.409.5393
Acknowledgements
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We acknowledge the coaching and mentoring of Dr. Lynx McClellan in assisting with the development of the research course. She was instrumental in providing encouragement, assistance, and scholarly course activities throughout the semester. We also wish to thank Martha Walls and Betty Grubb for their clinical and administrative expertise. This project would not have been possible without their interest in exploring new and creative ways in providing professional development opportunities based on national guidelines and practice performance indicators for nurses on the unit.
1
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INTRODUCTION
It is common for nursing undergraduate students to attend clinical placements in
RI PT
hospital settings, be assigned to a nurse, and work with that nurse to render patient care. Students benefit, but nurses have questioned their personal benefit in working with students. Nurses have challenging workloads in managing complex patients with high acuity, and
SC
managing student learning experiences may compound their workload. What is not common is to facilitate a cooperative learning environment involving the knowledge of evidence based
M AN U
practice for both students and nurses. A new process of collaborating with agencies to promote a cooperative learning model of knowledge of evidence based care was developed and identified as the Collaborative Approach and Learning Cooperatives (CALC) Model. This systematic, calculated approach promotes a two-way learning method where both students
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and nurses benefit, and hospitals and universities maximize personnel and financial resources to optimize knowledge of evidence- based care. Collaboration occurs from working together to achieve something that could not be accomplished through individual work (Bronstein, 2003).
EP
Cooperative learning happens when small groups actively participate in learning and share
AC C
what they have learned with others. Collaboration and cooperative learning are foundational to nursing education and practice. The specific aim of this study was to apply the Collaborative Approach and Learning Cooperatives (CALC) Model in an undergraduate nursing research course.
BACKGROUND
1
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Knowles’ Adult Learning Theory and Cooperative Learning Nurse educators in academia and in the hospital setting struggle in knowing which
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teaching/learning theory may be best to apply to a diversified group in the classroom or workforce. In nursing programs, diversity is seen in gender, race, and age. The National League for Nursing (2012) reported students enrolled in basic registered nurse (RN) programs are 15%
SC
male, 24% minority, and on average 15% was over age 30. In the workforce, the average age of a registered nurse is 50, and the percentage of working nurses over the age of 50 is 53%
M AN U
(American Nurses Association, 2014). Approximately 55% of the RN workforce holds a bachelor’s or higher degree (American Nurses Association, 2014). Knowles’ Adult Learning Theory has been applied in both nursing education programs and in registered nurse educational development programs (Curran, 2013; Keefe, 2014). Knowles’ Adult Learning
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Theory addresses five assumptions of adult learners; self-concept, adult learner experiences, readiness to learn, orientation to learning, and motivation to learn (Knowles et. al, 1998). Nurses are a population of adult learners who can easily apply Knowles’ theory, and applying
EP
Knowles’ theory can involve many approaches. Cooperative learning is a teaching strategy that
AC C
can be used with Knowles’ Adult Learning Theory. Cooperative learning involves establishing small teams of diverse individuals who
explore a topic together to gain more in-depth insights. Smith-Stoner and Molle (2010) conducted a study in which cooperative learning was integrated in a class and discovered students were engaged in highly structured activities. The most effective activities were those that included content that was meaningful and relevant to the student. Knowles’ Adult 2
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Learning Theory and cooperative learning were foundational to building a teaching strategy in an undergraduate nursing research course involving collaboration with hospital administrators.
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Collaborative Approach in Learning and Applying Scholarly Inquiry in an Evidence Based Project Undergraduate nursing students are often involved in service learning projects as a means of giving back to the community. These types of projects can be anything from assessing
SC
community health needs to determining flu vaccination rates of the homeless (Krumwiede et al., 2015; Metcalfe and Sexton, 2014). Service learning projects may be community focused
M AN U
with an identified community partner, but no cooperative learning gains are routinely identified. A recent study, identifying collaborative partnerships, highlighted the involvement of healthcare providers and academicians in assessment, design, and evaluation of a midwifery program (Carter et al., 2015). No studies discuss calculated, cooperated learning approaches
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where intentional designing of a research, evidenced based activity between university nursing faculty and hospital administrators promoted knowledge of evidence based care practices.
EP
Typically, learning is directed to students in a classroom and is not inclusive of others such as nurses on a unit. An innovative approach in teaching an undergraduate research course
AC C
was developed to involve hospital administrators working with faculty to design a research project for students with an evidenced based focus and to present at the hospital to educate nurses about the state of the science related to evidence based guidelines, core measures, and national safety goals (Ericksen, 2010; Mascia et al., 2009). This collaborative approach between the university and the hospital fostered cooperative learning between students and nurses. An
3
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innovative teaching strategy model was developed based on this approach and called the CALC Model. See Figure 1.
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RESEARCH DESIGN A descriptive, pilot quality improvement project using the CALC Model (figure 1) was implemented in an undergraduate junior nursing research course at a southern university. The
SC
professor of the course contacted the Chief Nursing Officer and the Director of Clinical
Outcomes of an acute care hospital where students participate in clinical experiences. A
M AN U
meeting was held and key clinical issues related to The Joint Commission Core Measures and Hospital National Patient Safety Goals were identified (Ericksen, 2010; Mascia et al., 2009). Hospital leaders and the course professor discussed mutually beneficial scholarly projects for undergraduate nursing students to apply fundamental research skills and for nurses to update
TE D
their understanding of current evidence based clinical issues. The hospital administrators provided a list of current clinical issues and agreed to participate in the evaluation of the
EP
student posters, select the best posters, and display the chosen posters at the hospital on specific units relevant to the content of the posters for nurse education.
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Junior level undergraduate nursing students were provided a list of clinical concerns
identified by the hospital administrators and based on national performance outcomes measures of the Joint Commission and National Patient Safety Goals. See Table 1. Students were placed in small teams to promote cooperative learning, and the teams selected a clinical question of interest to them. Students wrote a related PICOT (P- population/disease; I – intervention or variable of interest; C – comparison; O – outcome; T – time) question 4
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(Echevarria and Walker, 2014; Riva et al., 2012). They conducted a review of the literature using CINAHL, Medline, ProQuest, Cochrane, PubMed, Web of Science, Scholar Google, and limited
RI PT
their search to English only. Large searches were narrowed by combining key words related to the PICOT question. Students typically narrowed searches to obtain between eight and fifteen articles specifically related to the PICOT question.
SC
Students followed SQUIRE guidelines to critically appraise articles (Ogrinc et al, 2015). Students conducted a comprehensive review of literature, synthesized and summarized the
M AN U
information and results, identified application to practice, and developed recommendations for the future. The student teams wrote a summation paper inclusive of a review of literature, results, conclusions, applications to practice, and future recommendations. Graphics were encouraged on the poster if appropriate and relative to the understanding of the PICOT
See Table 2.
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question and the evidence. Posters were assessed, evaluated, and graded based on a rubric.
EP
RESULTS
Seventy-five students were involved in developing seventeen posters. A poster template
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was required by all students for consistency of content and layout. Posters were displayed in the College of Nursing and were graded based on peer review, professor evaluation, and hospital administrator evaluation. Seven posters were selected to be on temporary display at the collaborating hospital for a certain amount of time. Hospital administrators chose the posters based on content, clarity, comprehensiveness of the review of the literature, clear summary of the literature results, and realistic applications to practice. Certificates identifying 5
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collaborative learning and evaluation were provided to all students, and special recognition was awarded to the teams who had a poster were chosen for display at the hospital. Nurses at the
RI PT
area hospital were able to view the displayed posters and implement best practice based on evidence provided by students. Both the hospital and the university leveraged resources,
nurses. DISCUSSION
SC
optimized personnel, and produced beneficial learning outcomes to students and hospital
M AN U
Transforming patient care practices is challenging when financial resources are strained, workforce personnel is limited, and patient acuity is increased. Forming practice collaboratives can facilitate the knowledge of best practice by engaging interprofessional teams to promote cooperative learning. This was the first time faculty and hospital administrators met to discuss
TE D
opportunities to collaborate about designing a research project that would benefit both students and nurses. The CALC Model fostered new working relations with area partners,
EP
students, and nurses in the community. Undergraduate nursing students not only met a course requirement, but they stated they had “fun” applying research principles to “real issues.” The
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connection between theory, didactic, and practice became a seamless transition of learning and application. Nurses did not have to leave the unit for professional development classes as the posters were directly displayed on relevant units. Nurses were able to review evidence based practice guidelines related to initiatives at the hospital based on core measures and national patient safety goals. Lessons Learned 6
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Future changes include invitations to hospital administrators to visit faculty and students on campus at the beginning of the semester instead of the end of the semester.
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Students were not sure who would be involved in their evaluation, and this was a source of confusion and frustration. In addition to a paper certificate, a modest financial incentive will be provided to first, second, and third place winners in the future to encourage competition and
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assist in the cost of the professional production of the poster. Some posters lacked professional appearance. A repository of examples of research posters is now available to students so they
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know what the final product is to resemble. Students evaluated the learning the process, but nurses were not provided an opportunity to provide feedback about the learning process with student involvement. In the future, an instrument will be developed to assess both student and nurse satisfaction with the CALC Model approach to cooperative learning and learning
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effectiveness.
Recommendations and Future Directions
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New ideas and frameworks of teaching are needed as healthcare providers and faculty address a growing population of acutely ill patients with complicated health problems. These
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patients will continue to require more health services and continue to have issues associated with access to healthcare services. Collaborative partnerships and cooperative learning strategies can assist in the transformation required to meet dynamic healthcare demands and implement evidence based care. Teaching the skills of collaboration to student nurses requires an active learning approach that incorporates conceptual learning and active practice in cooperative endeavors. In this quality improvement study, students were able to apply 7
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collaborative concepts and cooperative learning techniques from an evidenced based practice perspective as well as a more diffuse systems approach. When hospital administrators became
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part of the process and provided cogent clinical problems from a micro and macro perspective and assisted in the evaluation process, students were able to place value and meaning to
scholarly learning activities. Additionally, students working in teams by reflecting, problem-
SC
solving, and writing and creating posters demonstrated cooperative learning. They also
produced a professional product by working together that will be appropriate for inclusion on
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their resume. Finally, the academic/clinical link generated valuable community connections. This project has also been replicated in the Doctorate of Nursing Practice program with considerable success including national dissemination of the scholarly work produced. Future plans include expanding this study, focusing on the integration of collaborative learning using
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student and nurse feedback, and measuring learning outcomes. Another phase of this project will be to design a study to identify patient and hospital outcomes related to collaborative
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approaches through cooperative learning activities.
8
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REFERENCES American Nurses Association, 2014. Fast facts: The nursing workforce 2014: Growth, salaries, education, demographics, & trends.
kforce/Fast-Facts-2014-Nursing-Workforce.pdf.
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http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/wor
Bronstein, L.R., 2003. A model fo interdisciplinary collaboration. Social Work, 48(3), 297-306.
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Carter, A. G., Sidebotham, M., Creedy, D.K, Fenwick, J., Gamble, J., 2015. Strengthening
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partnerships: The involvement of health care providers in the evaulation of authentic assesment within midwifery undergraduate education. Nurse Education in Practice, 15(4), 327-332. Doi: 10.1016/j.nepr.2015.01.013
Curran, M., 2013. The teaching styles and use of adult learning theory among nursing
EBSCOhost.
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professional development educators. Retrieved from CINAHL Plus with Full Text,
Echevarria, I.M., Walker, S., 2014. To make your case, start with a PICOT question. Nursing,
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44(2), 18-19. http://dx.doi.org/10.1097/01.NURSE.0000442594.00242.f9. Ericksen, A.B., 2010. Safety first: the Joint Commission shines the spotlight on patient safety
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protocols. Healthcare Traveler, 17(11), 30. Keefe, E., 2014. Exploration of the learning styles of the multigenerational nursing workforce. Retrieved from CINAHL Plus with Full Text, EBSCOhost. Knowles, M., Holton, E., Swanson, R., 1998. The Adult Learner, Fifth edition: The Definitive Classic in Adult Education and Human Resource Development. Butterworth-Heinemann; Woburn, MA. 9
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Krumwiede, K., Van Gelderen, S., Krumwiede, N., 2015. Academic hospital partnerships: Conducting a community health needs assessment as a service learning project. Public
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Health Nursing, 32(4), 359-367. Doi10.1111/phn.12159 Mascia, A.L., Richter, K.M., Convery, P., Haydar, Z., 2009. Linking Joint Commission inpatient core measures and national patient safety goals with evidence. Baylor University Medical
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Center Proceedings, 22(2), 103-111.
Metcalfe, S., Sexton, E., 2014. An academic-community partnership to address the flu
doi:10.1111/phn.12088
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vaccination rates of the homeless. Public Heatlh Nursing, 31(2), 175-182.
National League for Nursing, 2012. Annual survey executive summary final 061412: Findings from the annual survey of schools of nursing academic year 2010-2011.
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http://www.nln.org/docs/default-source/professional-developmentprograms/exec_summary_1011.pdf?sfvrsn=4 Ogrinc, G., Davies, L., Goodman, D, Batalden, P., Davidoff, F., Stevens, D., 2015. SQUIRE 2.0
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(Standards for quality improvement reporting excellence): Revised publication guidelines from a detailed consensus process. BMJ Qaulity & Safety, O, 2017. Doi: 10.1136/bmjqs-
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2015-004411.
Ovretveit, J., Hempel, S., Magnabosco, J.L., Mittman, B.S., Rubenstein, L.V., Ganz, D.A., 2014. Guidance for research-practice partnerships (R-PPs) and collaborative research. Journal of Health Organization & Management, 28(1), 115-126.
10
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Riva, J.J., Malik, K.M.P., Burnie, S.J., Endicott, A.R., Busse, J.W., 2012. What is your research question? An introduction to the PICOT format for clinicians. Journal of the Canadian
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Chiropractic Association, 56(3), 167-171. Smith-Stoner, M., Molle, M., 2010. Collaborative action research: Implementation of
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cooperative learning. Journal of Nursing Education, 49(6), 312-318.
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Table 1. Clinical Questions Derived from the Joint Commission Core Measures and the Hospital National Patient Safety Goals
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1. In hospitalized patients, what is the best practice for Foley catheter care to prevent infections? 2. In hospitalized patients, what is the best practice for Foley catheter insertion to prevent infections? 3. In hospitalized patients, what is the best practice to prevent intravenous catheter infections? 4. In hospitalized patients, what is the best practice to prevent urinary tract infections? 5. In hospitalized patients, what is the best practice to prevent ventilator-associated pneumonia? 6. In critical care areas, what different types of ventilator-associated bundles are promoted, and what are the associated outcomes? 7. In mechanically ventilated patients, what is the best practice to provide oral hygiene to prevent ventilator-associated pneumonia? Look at chlorahexidine versus water 8. In hospitalized patients, what is the best practice to promote optimal outcomes after colon surgery? Preadmission testing Pre-operative prep Education 9. In hospitalized patients, what is the best practice to promote optimal outcomes after hysterectomy? Preadmission testing Pre-operative prep Education 10. In hospital settings, what is best practice to prevent the spread of C-diff? Cleaning products (bleach versus Virex (used at Crestwood) Cleaning practice (identify frequency: routinely on daily basis – or after each patient) Cleaning protocol (what is to be cleaned and how? – all surfaces or bed, commode, and sink only?) What is impact of bleach on equipment? 11. In hospital settings what is best practice for cleaning of low-level equipment? Cleaning protocol for stethoscopes, thermometers, glucometers, blood pressure cuff, blood pressure machine, staff ID badges. Identify other common use items between patients
1
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Table 2. Assessment and Evaluation of Poster Presentation Assessment and Evaluation of Poster Presentation
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3.Review of Literature
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2.PICOT Question
Clear presentation of 1) need to apply evidence in practice, 2) importance of question being asked), and 3) identification of challenges in helping students implement evidence in practice. The PICOT question is clearly focused and researchable, and all elements are identified appropriately. Clear and comprehensive ROL provided with appropriate references. Themes relative to the PICOT question are included. Synthesis of the results presented in a clear and coherent manner. Conclusions are well justified by the evidence.
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1.Contextual clarity
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SC
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Reviewers Group Number_____ Names of Reviewers:________________________ _______________________ Group Number of Poster to be Reviewed______ Names of Presenters: ________________________ _______________________ ________________________ ________________________ _______________________ Review the Poster Assessment and Evaluation Rubric below and circle 1, 2, or 3 in each category based on the poster and oral presentation. Sum the scores with the maximum score being 21. Sum of Scores: ____________ CATEGORY 3 2 1
4. Results
5.Conclusion
6. Application to
Clear and direct 2
Clear presentation of two of the three elements required.
Clear presentation of one of the three elements required.
Only 3 elements of the PICOT question are identified.
The question is poorly defined and written. 2 or less PICOT elements are included. ROL is sparse and lacks relevancy to the PICOT questions. .
ROL is incomplete, lacks synthesis, and is not comprehensive.
Lacks synthesis of the results.
No results provided.
Conclusions Conclusions are generally follow the incomplete or unclear evidence. relative to the evidence provided. Some applications Lacks clarity and
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9.Verbal Explanation
3
congruency in applications based on PICOT and evidence. Not related to evidence or results.
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8.Poster Layout
identified, but not clear in how to implement. Lacks depth and details of recommendations based on evidence. The eight elements are present, but are not easy to follow. No graphics included to attract the reader.
Some of the elements are missing, making the poster difficult to follow. No reader attraction is present.
SC
7. Future Recommendations
application to practice. Methods of application identified. Lists plausible recommendations based on evidence and unanswered questions. The following five elements of 1) title, 2) names and affiliation, 3) PICOT question, 4) ROL, 5) results, 6) conclusions., 7) application to practice, 8.)Future recommendations are easily identified in a logical order. Colors, design, and overall layout attracts the reader. Explanations accurately reflect and enhance the poster, linking to information beyond the poster. Questions are clearly answered.
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Practice
Explanations accurately reflect the poster, and questions are answered.
Explanations are unclear and are incongruent with evidence
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Figure 1. Collaborative Approach and Learning Cooperatives (CALC) Model
1
S1471-5953(16)30010-5
DOI:
10.1016/j.nepr.2016.03.008
Reference:
YNEPR 2104
To appear in:
Nurse Education in Practice
Received Date: 16 September 2014 Revised Date:
2 February 2016
Accepted Date: 25 March 2016
Please cite this article as: O’Neal, P.V., Jarosinski, J.M., A new model in teaching undergraduate research: A collaborative approach and learning cooperatives, Nurse Education in Practice (2016), doi: 10.1016/j.nepr.2016.03.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title Page Title:
RI PT
A NEW MODEL IN TEACHING UNDERGRADUATE RESEARCH: A COLLABORATIVE APPROACH AND LEARNING COOPERATIVES
M AN U
SC
First and Corresponding Author: Pamela V. O’Neal, Associate Professor University of Alabama in Huntsville College of Nursing 301 Sparkman Drive Huntsville, Alabama 35811 USA Email: [email protected] Phone: international dialing prefix 011 and national dialing prefix+1 and phone number 256.426.8275
Word count: 1,777
TE D
Second Author: Judith M. Jarosinski, Associate Professor Salisbury University, Department of Nursing, Salisbury, MD USA Email: [email protected] Phone: +011256.910.409.5393
Acknowledgements
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EP
We acknowledge the coaching and mentoring of Dr. Lynx McClellan in assisting with the development of the research course. She was instrumental in providing encouragement, assistance, and scholarly course activities throughout the semester. We also wish to thank Martha Walls and Betty Grubb for their clinical and administrative expertise. This project would not have been possible without their interest in exploring new and creative ways in providing professional development opportunities based on national guidelines and practice performance indicators for nurses on the unit.
1
ACCEPTED MANUSCRIPT
INTRODUCTION
It is common for nursing undergraduate students to attend clinical placements in
RI PT
hospital settings, be assigned to a nurse, and work with that nurse to render patient care. Students benefit, but nurses have questioned their personal benefit in working with students. Nurses have challenging workloads in managing complex patients with high acuity, and
SC
managing student learning experiences may compound their workload. What is not common is to facilitate a cooperative learning environment involving the knowledge of evidence based
M AN U
practice for both students and nurses. A new process of collaborating with agencies to promote a cooperative learning model of knowledge of evidence based care was developed and identified as the Collaborative Approach and Learning Cooperatives (CALC) Model. This systematic, calculated approach promotes a two-way learning method where both students
TE D
and nurses benefit, and hospitals and universities maximize personnel and financial resources to optimize knowledge of evidence- based care. Collaboration occurs from working together to achieve something that could not be accomplished through individual work (Bronstein, 2003).
EP
Cooperative learning happens when small groups actively participate in learning and share
AC C
what they have learned with others. Collaboration and cooperative learning are foundational to nursing education and practice. The specific aim of this study was to apply the Collaborative Approach and Learning Cooperatives (CALC) Model in an undergraduate nursing research course.
BACKGROUND
1
ACCEPTED MANUSCRIPT
Knowles’ Adult Learning Theory and Cooperative Learning Nurse educators in academia and in the hospital setting struggle in knowing which
RI PT
teaching/learning theory may be best to apply to a diversified group in the classroom or workforce. In nursing programs, diversity is seen in gender, race, and age. The National League for Nursing (2012) reported students enrolled in basic registered nurse (RN) programs are 15%
SC
male, 24% minority, and on average 15% was over age 30. In the workforce, the average age of a registered nurse is 50, and the percentage of working nurses over the age of 50 is 53%
M AN U
(American Nurses Association, 2014). Approximately 55% of the RN workforce holds a bachelor’s or higher degree (American Nurses Association, 2014). Knowles’ Adult Learning Theory has been applied in both nursing education programs and in registered nurse educational development programs (Curran, 2013; Keefe, 2014). Knowles’ Adult Learning
TE D
Theory addresses five assumptions of adult learners; self-concept, adult learner experiences, readiness to learn, orientation to learning, and motivation to learn (Knowles et. al, 1998). Nurses are a population of adult learners who can easily apply Knowles’ theory, and applying
EP
Knowles’ theory can involve many approaches. Cooperative learning is a teaching strategy that
AC C
can be used with Knowles’ Adult Learning Theory. Cooperative learning involves establishing small teams of diverse individuals who
explore a topic together to gain more in-depth insights. Smith-Stoner and Molle (2010) conducted a study in which cooperative learning was integrated in a class and discovered students were engaged in highly structured activities. The most effective activities were those that included content that was meaningful and relevant to the student. Knowles’ Adult 2
ACCEPTED MANUSCRIPT
Learning Theory and cooperative learning were foundational to building a teaching strategy in an undergraduate nursing research course involving collaboration with hospital administrators.
RI PT
Collaborative Approach in Learning and Applying Scholarly Inquiry in an Evidence Based Project Undergraduate nursing students are often involved in service learning projects as a means of giving back to the community. These types of projects can be anything from assessing
SC
community health needs to determining flu vaccination rates of the homeless (Krumwiede et al., 2015; Metcalfe and Sexton, 2014). Service learning projects may be community focused
M AN U
with an identified community partner, but no cooperative learning gains are routinely identified. A recent study, identifying collaborative partnerships, highlighted the involvement of healthcare providers and academicians in assessment, design, and evaluation of a midwifery program (Carter et al., 2015). No studies discuss calculated, cooperated learning approaches
TE D
where intentional designing of a research, evidenced based activity between university nursing faculty and hospital administrators promoted knowledge of evidence based care practices.
EP
Typically, learning is directed to students in a classroom and is not inclusive of others such as nurses on a unit. An innovative approach in teaching an undergraduate research course
AC C
was developed to involve hospital administrators working with faculty to design a research project for students with an evidenced based focus and to present at the hospital to educate nurses about the state of the science related to evidence based guidelines, core measures, and national safety goals (Ericksen, 2010; Mascia et al., 2009). This collaborative approach between the university and the hospital fostered cooperative learning between students and nurses. An
3
ACCEPTED MANUSCRIPT
innovative teaching strategy model was developed based on this approach and called the CALC Model. See Figure 1.
RI PT
RESEARCH DESIGN A descriptive, pilot quality improvement project using the CALC Model (figure 1) was implemented in an undergraduate junior nursing research course at a southern university. The
SC
professor of the course contacted the Chief Nursing Officer and the Director of Clinical
Outcomes of an acute care hospital where students participate in clinical experiences. A
M AN U
meeting was held and key clinical issues related to The Joint Commission Core Measures and Hospital National Patient Safety Goals were identified (Ericksen, 2010; Mascia et al., 2009). Hospital leaders and the course professor discussed mutually beneficial scholarly projects for undergraduate nursing students to apply fundamental research skills and for nurses to update
TE D
their understanding of current evidence based clinical issues. The hospital administrators provided a list of current clinical issues and agreed to participate in the evaluation of the
EP
student posters, select the best posters, and display the chosen posters at the hospital on specific units relevant to the content of the posters for nurse education.
AC C
Junior level undergraduate nursing students were provided a list of clinical concerns
identified by the hospital administrators and based on national performance outcomes measures of the Joint Commission and National Patient Safety Goals. See Table 1. Students were placed in small teams to promote cooperative learning, and the teams selected a clinical question of interest to them. Students wrote a related PICOT (P- population/disease; I – intervention or variable of interest; C – comparison; O – outcome; T – time) question 4
ACCEPTED MANUSCRIPT
(Echevarria and Walker, 2014; Riva et al., 2012). They conducted a review of the literature using CINAHL, Medline, ProQuest, Cochrane, PubMed, Web of Science, Scholar Google, and limited
RI PT
their search to English only. Large searches were narrowed by combining key words related to the PICOT question. Students typically narrowed searches to obtain between eight and fifteen articles specifically related to the PICOT question.
SC
Students followed SQUIRE guidelines to critically appraise articles (Ogrinc et al, 2015). Students conducted a comprehensive review of literature, synthesized and summarized the
M AN U
information and results, identified application to practice, and developed recommendations for the future. The student teams wrote a summation paper inclusive of a review of literature, results, conclusions, applications to practice, and future recommendations. Graphics were encouraged on the poster if appropriate and relative to the understanding of the PICOT
See Table 2.
TE D
question and the evidence. Posters were assessed, evaluated, and graded based on a rubric.
EP
RESULTS
Seventy-five students were involved in developing seventeen posters. A poster template
AC C
was required by all students for consistency of content and layout. Posters were displayed in the College of Nursing and were graded based on peer review, professor evaluation, and hospital administrator evaluation. Seven posters were selected to be on temporary display at the collaborating hospital for a certain amount of time. Hospital administrators chose the posters based on content, clarity, comprehensiveness of the review of the literature, clear summary of the literature results, and realistic applications to practice. Certificates identifying 5
ACCEPTED MANUSCRIPT
collaborative learning and evaluation were provided to all students, and special recognition was awarded to the teams who had a poster were chosen for display at the hospital. Nurses at the
RI PT
area hospital were able to view the displayed posters and implement best practice based on evidence provided by students. Both the hospital and the university leveraged resources,
nurses. DISCUSSION
SC
optimized personnel, and produced beneficial learning outcomes to students and hospital
M AN U
Transforming patient care practices is challenging when financial resources are strained, workforce personnel is limited, and patient acuity is increased. Forming practice collaboratives can facilitate the knowledge of best practice by engaging interprofessional teams to promote cooperative learning. This was the first time faculty and hospital administrators met to discuss
TE D
opportunities to collaborate about designing a research project that would benefit both students and nurses. The CALC Model fostered new working relations with area partners,
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students, and nurses in the community. Undergraduate nursing students not only met a course requirement, but they stated they had “fun” applying research principles to “real issues.” The
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connection between theory, didactic, and practice became a seamless transition of learning and application. Nurses did not have to leave the unit for professional development classes as the posters were directly displayed on relevant units. Nurses were able to review evidence based practice guidelines related to initiatives at the hospital based on core measures and national patient safety goals. Lessons Learned 6
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Future changes include invitations to hospital administrators to visit faculty and students on campus at the beginning of the semester instead of the end of the semester.
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Students were not sure who would be involved in their evaluation, and this was a source of confusion and frustration. In addition to a paper certificate, a modest financial incentive will be provided to first, second, and third place winners in the future to encourage competition and
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assist in the cost of the professional production of the poster. Some posters lacked professional appearance. A repository of examples of research posters is now available to students so they
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know what the final product is to resemble. Students evaluated the learning the process, but nurses were not provided an opportunity to provide feedback about the learning process with student involvement. In the future, an instrument will be developed to assess both student and nurse satisfaction with the CALC Model approach to cooperative learning and learning
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effectiveness.
Recommendations and Future Directions
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New ideas and frameworks of teaching are needed as healthcare providers and faculty address a growing population of acutely ill patients with complicated health problems. These
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patients will continue to require more health services and continue to have issues associated with access to healthcare services. Collaborative partnerships and cooperative learning strategies can assist in the transformation required to meet dynamic healthcare demands and implement evidence based care. Teaching the skills of collaboration to student nurses requires an active learning approach that incorporates conceptual learning and active practice in cooperative endeavors. In this quality improvement study, students were able to apply 7
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collaborative concepts and cooperative learning techniques from an evidenced based practice perspective as well as a more diffuse systems approach. When hospital administrators became
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part of the process and provided cogent clinical problems from a micro and macro perspective and assisted in the evaluation process, students were able to place value and meaning to
scholarly learning activities. Additionally, students working in teams by reflecting, problem-
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solving, and writing and creating posters demonstrated cooperative learning. They also
produced a professional product by working together that will be appropriate for inclusion on
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their resume. Finally, the academic/clinical link generated valuable community connections. This project has also been replicated in the Doctorate of Nursing Practice program with considerable success including national dissemination of the scholarly work produced. Future plans include expanding this study, focusing on the integration of collaborative learning using
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student and nurse feedback, and measuring learning outcomes. Another phase of this project will be to design a study to identify patient and hospital outcomes related to collaborative
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approaches through cooperative learning activities.
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REFERENCES American Nurses Association, 2014. Fast facts: The nursing workforce 2014: Growth, salaries, education, demographics, & trends.
kforce/Fast-Facts-2014-Nursing-Workforce.pdf.
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http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/wor
Bronstein, L.R., 2003. A model fo interdisciplinary collaboration. Social Work, 48(3), 297-306.
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Carter, A. G., Sidebotham, M., Creedy, D.K, Fenwick, J., Gamble, J., 2015. Strengthening
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partnerships: The involvement of health care providers in the evaulation of authentic assesment within midwifery undergraduate education. Nurse Education in Practice, 15(4), 327-332. Doi: 10.1016/j.nepr.2015.01.013
Curran, M., 2013. The teaching styles and use of adult learning theory among nursing
EBSCOhost.
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professional development educators. Retrieved from CINAHL Plus with Full Text,
Echevarria, I.M., Walker, S., 2014. To make your case, start with a PICOT question. Nursing,
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44(2), 18-19. http://dx.doi.org/10.1097/01.NURSE.0000442594.00242.f9. Ericksen, A.B., 2010. Safety first: the Joint Commission shines the spotlight on patient safety
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protocols. Healthcare Traveler, 17(11), 30. Keefe, E., 2014. Exploration of the learning styles of the multigenerational nursing workforce. Retrieved from CINAHL Plus with Full Text, EBSCOhost. Knowles, M., Holton, E., Swanson, R., 1998. The Adult Learner, Fifth edition: The Definitive Classic in Adult Education and Human Resource Development. Butterworth-Heinemann; Woburn, MA. 9
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Krumwiede, K., Van Gelderen, S., Krumwiede, N., 2015. Academic hospital partnerships: Conducting a community health needs assessment as a service learning project. Public
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Health Nursing, 32(4), 359-367. Doi10.1111/phn.12159 Mascia, A.L., Richter, K.M., Convery, P., Haydar, Z., 2009. Linking Joint Commission inpatient core measures and national patient safety goals with evidence. Baylor University Medical
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Center Proceedings, 22(2), 103-111.
Metcalfe, S., Sexton, E., 2014. An academic-community partnership to address the flu
doi:10.1111/phn.12088
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vaccination rates of the homeless. Public Heatlh Nursing, 31(2), 175-182.
National League for Nursing, 2012. Annual survey executive summary final 061412: Findings from the annual survey of schools of nursing academic year 2010-2011.
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http://www.nln.org/docs/default-source/professional-developmentprograms/exec_summary_1011.pdf?sfvrsn=4 Ogrinc, G., Davies, L., Goodman, D, Batalden, P., Davidoff, F., Stevens, D., 2015. SQUIRE 2.0
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(Standards for quality improvement reporting excellence): Revised publication guidelines from a detailed consensus process. BMJ Qaulity & Safety, O, 2017. Doi: 10.1136/bmjqs-
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2015-004411.
Ovretveit, J., Hempel, S., Magnabosco, J.L., Mittman, B.S., Rubenstein, L.V., Ganz, D.A., 2014. Guidance for research-practice partnerships (R-PPs) and collaborative research. Journal of Health Organization & Management, 28(1), 115-126.
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Riva, J.J., Malik, K.M.P., Burnie, S.J., Endicott, A.R., Busse, J.W., 2012. What is your research question? An introduction to the PICOT format for clinicians. Journal of the Canadian
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Chiropractic Association, 56(3), 167-171. Smith-Stoner, M., Molle, M., 2010. Collaborative action research: Implementation of
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cooperative learning. Journal of Nursing Education, 49(6), 312-318.
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Table 1. Clinical Questions Derived from the Joint Commission Core Measures and the Hospital National Patient Safety Goals
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1. In hospitalized patients, what is the best practice for Foley catheter care to prevent infections? 2. In hospitalized patients, what is the best practice for Foley catheter insertion to prevent infections? 3. In hospitalized patients, what is the best practice to prevent intravenous catheter infections? 4. In hospitalized patients, what is the best practice to prevent urinary tract infections? 5. In hospitalized patients, what is the best practice to prevent ventilator-associated pneumonia? 6. In critical care areas, what different types of ventilator-associated bundles are promoted, and what are the associated outcomes? 7. In mechanically ventilated patients, what is the best practice to provide oral hygiene to prevent ventilator-associated pneumonia? Look at chlorahexidine versus water 8. In hospitalized patients, what is the best practice to promote optimal outcomes after colon surgery? Preadmission testing Pre-operative prep Education 9. In hospitalized patients, what is the best practice to promote optimal outcomes after hysterectomy? Preadmission testing Pre-operative prep Education 10. In hospital settings, what is best practice to prevent the spread of C-diff? Cleaning products (bleach versus Virex (used at Crestwood) Cleaning practice (identify frequency: routinely on daily basis – or after each patient) Cleaning protocol (what is to be cleaned and how? – all surfaces or bed, commode, and sink only?) What is impact of bleach on equipment? 11. In hospital settings what is best practice for cleaning of low-level equipment? Cleaning protocol for stethoscopes, thermometers, glucometers, blood pressure cuff, blood pressure machine, staff ID badges. Identify other common use items between patients
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Table 2. Assessment and Evaluation of Poster Presentation Assessment and Evaluation of Poster Presentation
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3.Review of Literature
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2.PICOT Question
Clear presentation of 1) need to apply evidence in practice, 2) importance of question being asked), and 3) identification of challenges in helping students implement evidence in practice. The PICOT question is clearly focused and researchable, and all elements are identified appropriately. Clear and comprehensive ROL provided with appropriate references. Themes relative to the PICOT question are included. Synthesis of the results presented in a clear and coherent manner. Conclusions are well justified by the evidence.
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1.Contextual clarity
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Reviewers Group Number_____ Names of Reviewers:________________________ _______________________ Group Number of Poster to be Reviewed______ Names of Presenters: ________________________ _______________________ ________________________ ________________________ _______________________ Review the Poster Assessment and Evaluation Rubric below and circle 1, 2, or 3 in each category based on the poster and oral presentation. Sum the scores with the maximum score being 21. Sum of Scores: ____________ CATEGORY 3 2 1
4. Results
5.Conclusion
6. Application to
Clear and direct 2
Clear presentation of two of the three elements required.
Clear presentation of one of the three elements required.
Only 3 elements of the PICOT question are identified.
The question is poorly defined and written. 2 or less PICOT elements are included. ROL is sparse and lacks relevancy to the PICOT questions. .
ROL is incomplete, lacks synthesis, and is not comprehensive.
Lacks synthesis of the results.
No results provided.
Conclusions Conclusions are generally follow the incomplete or unclear evidence. relative to the evidence provided. Some applications Lacks clarity and
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9.Verbal Explanation
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congruency in applications based on PICOT and evidence. Not related to evidence or results.
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8.Poster Layout
identified, but not clear in how to implement. Lacks depth and details of recommendations based on evidence. The eight elements are present, but are not easy to follow. No graphics included to attract the reader.
Some of the elements are missing, making the poster difficult to follow. No reader attraction is present.
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7. Future Recommendations
application to practice. Methods of application identified. Lists plausible recommendations based on evidence and unanswered questions. The following five elements of 1) title, 2) names and affiliation, 3) PICOT question, 4) ROL, 5) results, 6) conclusions., 7) application to practice, 8.)Future recommendations are easily identified in a logical order. Colors, design, and overall layout attracts the reader. Explanations accurately reflect and enhance the poster, linking to information beyond the poster. Questions are clearly answered.
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Practice
Explanations accurately reflect the poster, and questions are answered.
Explanations are unclear and are incongruent with evidence
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Figure 1. Collaborative Approach and Learning Cooperatives (CALC) Model
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