by Maura MacPhee

Quality and Safety Education for Nurses (QSEN) is making its way into undergraduate nursing curricula, and cognitive assessment of quality/safety knowledge is a component of NCLEX, the registered nurse licensure exam.

In our March 8^th brownbag, we discussed ways to integrate QSEN content in our own undergraduate nursing program. The article for this month’s brownbag (reference below) provides great, creative suggestions for QSEN integration based on the authors’ development of a first semester communications program. The authors used a QSEN framework to design content and assessments for in-class, skills labs, field work and clinical practicum. Some lessons from this article:

1. Determine those critical QSEN competencies you want per term. Don’t do too much at one time. In the article, educators reinforced five critical safety behaviours: hand washing, introductions, patient-centered care communications, double patient identifiers and SBAR .
2. Use different teaching modalities and cases/simulations to reinforce critical competencies. In the article, the educators used skills lab simulations and virtual simulations, readings, videos and movies and role play. Self-reflective assignments included reflection summaries after role play,

2-minute papers in class, online discussion board postings, reflective logs after field experiences (interviewing patients), and after simulations.

3. Get faculty members together per semester to integrate curricular content and resources and pedagogical strategies. Remember to reinforce, reinforce, reinforce critical competencies any way you can!

Resources:

Brady, D. (2011). Using quality and safety education for nurses (QSEN) as a pedagogical structure for course redesign and content. International Journal of Nursing Education Scholarship, 8(1), 1-18.

NCLEX blueprint April 2016: https://www.ncsbn.org/RN_Test_Plan_2016_Final.pdf

By Maura MacPhee

The brown bag article for today drew some excellent conversation among participants. Although there were criticisms about the lack of evidence in the article, the group agreed that the topic was worth discussing—socialization to teaching.

Our discussion focused on team teaching. When faculty members work effectively in teams, real synergy results from the range of pedagogical knowledge and theoretical and clinical expertise. Unfortunately, with work overload, many faculty members find it more convenient to break off from teamwork and create their course materials on their own.

What’s needed to break old habits? One participant in the brown bag, for instance, mentioned that the UBC School of Nursing has aspired to do team teaching in the past. We strategized on ways to bring us back together as effective teams.

Some suggestions:

1. “Begin small.” Start with one course and invite interested faculty members to meet for a half-day to review/revise the syllabus, course materials and evaluation strategies.
2. “Bring in some new blood.” Invite adjuncts, clinical instructors and continuing clinical associates (CAs) to be part of the mix. In other words, don’t pre-determine who should be on course teaching teams-invite previous/current course leaders and open it up to anyone who is interested in participating.
3. “Mentor as much as possible.” Although planned brownbags, workshops and team meetings provide opportunities for interested faculty members to gather and promote learning among each other, learning through a wise mentor is, perhaps, the best way to learn on the jobJ
4. “Culture matters.” All of us need to promote continuous learning, adult learning and curiosity among our peers.

Please post your comments. Thanks, Maura

By Ranjit Kaur Dhari (1), Joanne Ricci (2) & Alysha McFadden (3)
(1) Lecturer,  N336 Course Leader
(2) Senior Instructor, N427 Course Leader
(3) Clinical Associate,  Evergreen Community Health Center.

Each year the Quintessence Breastfeeding Challenge takes place around the world. “This fun event is a challenge for which geographic area (province, state or territory) has the most breastfeeding babies, as a percentage of the birthrate, “latched on” at 11am local time. To celebrate breastfeeding and milk-banking, and demonstrate promotion, protection and support for breastfeeding women and their families. It’s a chance for education and peer support done in a fun social way.” (http://www.babyfriendly.ca/general-information.aspx) This year’s theme emphasized the need for good, ongoing support from partners, families and health care professionals to help women be successful when choosing to breastfeed their babies.

UBC SON students June Chan & Kyle Lescisin (along with BCIT nursing students) were instrumental in the planning and implementation of this event in Richmond Community with Richmond Public Health Nurses. The goal of all displays, games and fun was to promote, support and protect breastfeeding. June and Kyle managed a resource table where they provided health information to build capacity of families.

By participating in this event students learnt about the socio cultural determinants of breastfeeding, the public barriers that exist for breastfeeding families. Students also had the opportunity to practice knowledge gained from their Relational Practice thread courses by establishing rapport and communicating with families from many different culture.

In photo: UBC Nursing students-  Marina (Juana) Cornejo Chavez, Jenessa Dilley, and Lorelei Arteaga.

By Ranjit Kaur Dhari (1), Joanne Ricci (2) & Alysha McFadden (3)
(1) Lecturer,  N336 Course Leader
(2) Senior Instructor, N427 Course Leader
(3) Clinical Associate,  Evergreen Community Health Center.

UBC nursing students spend part of a day twice in a 6 week rotation at the Union Gospel Mission (UGM) where they provide foot assessments and build rapport with residents in the downtown Eastside. The students also get a tour of the UGM and learn about the unique programs the UGM provides as well as the history of the downtown Eastside. This experience highlights to students the importance of understanding how history impacts the social determinants of health for individuals, families, and populations who live in the downtown Eastside, while also allowing clients themselves to tell their own unique stories.

Prior to them being in this clinical setting student are prepared with classroom lecture with content on outreach nursing and in particular working in the DTES. They are shown the film “Bevel Up” filmed in Vancouver Downtown eastside where it follows nurses working with vulnerable populations on the streets. Their knowledge from Relational practice thread courses is further reinforced with discussions on collaborative relationships with clients, communication with challenging clients and setting boundaries and keeping oneself safe.

All nursing practice is grounded theory, hence learning about Outreach from the Minnesota Wheel of intervention as a model for practice in Public Health in our baccalaureate program is used in this unique setting. Follow-up from the foot soak in often brought back into the classroom in the way of discussion as various other interventions of the wheel are used to analyze the often complex clients that the students work with at the UGM foot soak clinic.

For many students, who are not from the Vancouver area or have not ever experienced this kind of marginalized population with many determinants of health affecting this population group- the experience is powerful to say the least. These students have the opportunity to debrief not only after the foot soaks session with the clinical nursing instructor but the following week in the classroom and via their personal journal if they wish which is required at various times throughout the 6 week rotation.

The experience and partnership have proven to be a win -win situation for all. The students are learning about living with adversity and engaging in many ways with this populations lived experience as the clients are receiving an ear to listen, health promotion counseling on a variety of topics such as nutrition, medication compliance and are receiving a warming foot soak, massage and a clean dry pair of socks.

By Maura MacPhee

• New emphasis on the importance of dignity in practice, compassion, patient-centered care (PCC)
• Curriculum challenges; systems challenges
  • What should we teach in our curriculum? What should healthcare organizations be doing?
    • The UK Francis Inquiry: worrying accounts of nurse failures to meet basic care standards + uphold ethical codes

“The reasons for these systems failures are many and complex, one potential problem area may be that nursing lacks the consistency of language and conceptual frameworks to synthesis nursing actions in practice…” (p.335).

• Nursing needs a systematic approach/an integrated way of thinking about nursing fundamentals
• International Learning Collaborative (http://intlearningcollab.org/)
• Theories, conceptual frameworks versus pragmatics

“The argument for the need for a more pragmatic and practical framework is to ensure that the basic physical and psychosocial needs of patients are embedded both in the practice and the thinking, reflection and assessment processes of the nurse” (p.393)

• Fundamentals of Care Template
  • The foundation for PCC
    • For education
    • How stroke survivors experienced care during acute/recovery phases
  • Systems Framework
    • The nurse makes a moral commitment to care: the patient-nurse relationship
    • Assessment→practical actions related to fundamentals of care
    • The nurse-patient interacting with the broader healthcare system
  • What do we know?
    • Nurses focus on tasks versus relationships
      • There is choice

“Therefore, we argue that for each encounter with a patient, the nurse can choose either to engage in a way that reflects this ‘commitment to care’ or operate in a way that executes a series of tasks” (p. 336).

• Being present in the moment
  • Choosing to “be for the other” or “not be for the other.” (p. 336)
  • Focus on the patient versus self
    • Know how to establish a therapeutic relationship- “whether it be for 30 seconds or for 15 minutes or longer” (p. 336).
  • Effectiveness of the encounter=the patients’ experience
• Nurse sensitive outcomes
  • Positive outcomes versus negative outcomes
    • Self-esteem, comfort, dignity versus pressure ulcers, falls with injuries
  • Researchable questions
    • One research domain: identifying and testing how “nurses acquire skills around the fundamentals of care” ( 337).
  • Next brownbag will discuss current innovations in curriculum design and delivery

By Maura MacPhee

In our Brown Bag, we discussed what we should do as nurse educators to instill caring and compassion in students/new nurses. Faculty agreed that students want to do the right thing, but there are many negative forces in the workplace—examples of non-caring and focus on tasks.

What about “caring tasks?” Is it possible to teach relational practice and functional tasks at the same time? We need to always put the two together-and to expect students to exhibit caring behaviours as they carry out technical tasks.

Our students often feel that “they get it,” when we discuss relational practice, professional standards, code of ethics with them. At a conceptual level, they do get it. But how do we role model these concepts for them, and how do we operationalize and teach these concepts at the bedside for students to observe, practice and assimilate?

Perhaps we need to re-think our placements. Students need to begin in the program with opportunities to practice-reflect, practice-reflect: by instilling healthy patterns of self-reflection and “right” ways of doing and thinking, we can hopefully create self-confident nurses who will be able to succeed in negative work environments. Sites such as community centers and residential care facilities may give students time to gain self-confidence over the fundamentals of nursing care through an ethical/moral lens.

We often front-load students with the Foundations of Nursing-and then they go into clinical. Maybe we should start clinical right way and introduce foundational concepts as they experience them first-hand. Again, starting in “safe, slow-paced” environments might be better for them—than acute care sites with heavy workloads and chaotic work environments.

Do students need to be primed before entering a nursing program? Is it important to have students with care aide certificates or experience prior to entry? Some nursing programs are requiring care aide work/certification. Does this help or hurt if we want to teach fundamentals of caring?

UBC School of Nursing may apply to join the International Learning Collaborative (ILC). This collaborative promotes education and research related to fundamentals of nursing. Your thoughts?!

By Maura MacPhee

Our brown bag journal article, “Revolutionizing an accelerated baccalaureate curriculum,” was used to compare and contrast trends across the country with respect to accelerated BSN programs. The article describes curriculum transformation for one accelerated BSN program, Memorial University School of Nursing (MUnSoN), in Newfoundland/Labrador. UBC School of Nursing (SoN) is beginning curriculum transformation— review and discussion of other nursing faculty experiences is very pertinent to us. According to the article authors, almost 50% of Canadian Schools of Nursing offer an accelerated BSN version—typically 24 months. UBC’s program is 20 months: currently the shortest BSN program in Canada (to our knowledge).

Accelerated programs are attracting students born in the 1980s-1990s who typically have at least one college degree, considerable life experience and emotional maturity. These types of students prefer flexible curriculum delivery and multi-media learning options; and they are technologically savvy.

At UBC SoN, we introduced a flexible curriculum delivery model in 2013. Similar to the MUnSoN curriculum delivery model, we combine online learning with in-class active learning strategies, skills lab simulations, and a variety of clinical learning experiences. To stay current with actual/projected population healthcare needs, our faculty are providing more community-based experiential learning activities for students, and adult/older adult care in a major focus of our theory/practice content. We are fortunate to have several faculty with community health/public health experience and expertise in senior care.

In 2013, our SoN received internal educational grant funding to “blend” our undergraduate courses. Over a 2-year period, we converted 10% of in-class content to online—freeing up class “seat” time for students to participate in other learning opportunities. An example of new learning opportunities is interprofessional education (IPE) events where health disciplines students discuss patient cases and problem solve together (e.g., simulated teams). Our blended content includes commercial products, such as The Canadian Neighbourhood online vignettes of individuals and families and their intersections with healthcare providers in acute care and community care settings. Blended content also includes online modules that our faculty have developed and customized. We recently completed an online health policy module that will be foundational content for four of our undergraduate courses.

Although we have made progress with our flexible curriculum delivery model, a great deal of work remains. Schools of Nursing need to consider faculty release time to design, implement and evaluate new modes of curriculum delivery—and to ensure conceptual linkages across these different modes of delivery within and across courses. We know, for instance, that we have some great blended learning options in our courses, but we are not sure how well they connect with each other. We also know that students learn better when there are explicit conceptual linkages within and across courses—to help them more effectively, efficiently consolidate their learning. As a faculty, therefore, we need to take time to create seamless curriculum delivery of core concepts.

When MUnSoN went through its curriculum transformation, faculty planned their new curriculum around a vision of the nurse of the future: What types of nurses will we need to provide quality, safe care 5-to-10 years from now? To assist faculty visioning, there are a number of documents that propose what the future nurse will be like—and what types of competencies they will need to possess. MUnSoN faculty used the Institute of Medicine (IOM) Future of Nursing document and their regulatory body’s current entry-level requirements to craft a new curriculum with the following core concepts: leadership, health policy, systems improvement, research, evidence-based policy, teamwork, collaboration. Attached is a document I’ve put together with core concepts in futurist documents from the IOM and a ‘wish list’ from US Nurse Executives; and competency documents from the Canadian Association of Schools of Nursing and BC’s regulatory body, the College of Registered Nurses of BC. What is striking, to me, is that they are all similar, and I don’t see a lot of difference between our current core concepts and futurist concepts. I don’t see a lot of innovation or “outside the box” thinking when it comes to the future of nursing in North America. In BC, it seems that we’re going backwards. Health authorities are hiring on more and more practical nurses, and NPs are being under-utilized.

In our brown bag, we also compared/contrasted pre-requisites for accelerated BSN programs. MUnSoN, for instance, requires a Bachelor’s degree from another discipline, a GPA of at least 3.0 and Statistics, Biochemistry, Microbiology, Anatomy & Physiology. Our current UBC pre-requisites are not as rigorous as MUnSoN’s. In a recent conversation with a colleague from another SoN, we talked about pre-requisites. Her SoN requires Statistics and Microbiology. Statistics is seen as preparation for graduate work. In her words, “the hope is that BSN students will go on to graduate and doctoral-level work. Statistics primes them for it.” She explained that at their SoN, Microbiology seems to be important preparation for Pharmacology: “Our students do better in Pharm with Micro as a pre-requisite.” To establish rationale for their pre-requisites, her university did some careful groundwork and evaluation of their students’ theory/practice performance . An underlying message for me, is that Schools of Nursing need to carefully consider what pre-requisites will enhance student success-particularly in more challenging accelerated programs.

In our next brown bag, we will look at the nursing movement to “return to basics.” To whet your curiosity, check out “Reclaimining and Redefining the Fundamentals of Care” (2013) by Alison Kitson and colleagues at: https://digital.library.adelaide.edu.au/dspace/bitstream/2440/75843/1/hdl_75843.pdf.

Registration is ongoing for the CTLT Summer Institute, a series of workshops to be held on August 24-27. You could attend one, a few or all of the workshops.

Click on each workshop title to get a description of learning outcomes and to register:

AUGUST 24

Welcome to Teaching at UBC
Facilitators: Judy Chan, Farnaz Badiee and Adriana Brizeno-Garzon
9:15 a.m. – 11:45 a.m.
IKBLC, Lillooet Room

Course Design Considerations and Integrating Classroom Climate
Facilitators: Erin Yun, Jessica Earle-Meadows, Hanae Tsukada and Amy Perreault
1:15 p.m. – 3:45 p.m.
IKBLC, Lillooet Room

AUGUST 25

Developing Course Goals and Learning Objectives
Facilitators: Isabeau Iqbal, Marie Krbavac and Amy Perreault
9:15 a.m. – 11:45 a.m.
IKBLC, Lillooet Room

Video Production & Lightboard Demo for UBC Courses
Facilitators: Farnaz Badiee in collaboration with UBC Studios and IRC Studio
12:00 p.m. – 1:15 p.m.
Woodward Instructional Resources Centre Studios , Room B-32

Approaching Teaching as a Scholarly Activity
Facilitators: Adriana Brizeno-Garzon, Ido Roll and Andrea Han
1:15 p.m. – 3:45 p.m.
IKBLC, Lillooet Room

Leading Discussions (for TAs)
Facilitator: Jan Ludert
1:15 p.m. – 3:45 p.m.
IKBLC, Dodson Room

AUGUST 26

Teaching with Teaching Assistants (for Faculty)
Facilitators: Judy Chan and co-facilitator (TBD)
9:15 a.m. – 11:45 a.m.
IKBLC, Lillooet Room

TA-Instructor working relationship (for TAs)
Facilitators: Shaya Golparian and Jan Ludert
9:15 a.m. – 11:45 a.m.
IKBLC, Dodson Room

Participatory Learning Techniques for Flipped and Blended, Face-to-Face Environment
Facilitators: Hailan Chen, Namsook Jahng and Judy Chan
1:15 p.m. – 3:45 p.m.
IKBLC, Lillooet Room

AUGUST 27

Assessment and Evaluation
Facilitators: Andrea Han and Marie Krbavac
9:15 a.m. – 11:45 a.m.
IKBLC, Fraser Room

Copyright in the Classroom
Facilitators: Farnaz Badiee, Peter D James and Simonida Jocic
12:00 p.m. – 1:00 p.m.
IKBLC, Fraser Room

Engaging Students with Open Educational Resources
Facilitators: Christina Hendricks, Farnaz Badiee, Will Engle, Shawnna Parlongo, Daniel Munro, Jenna Omassi and Shawnna Parlongo
1:15 p.m. – 2:15 p.m.
IKBLC, Fraser Room

Presentation Skills (for TAs)
Facilitators: Jens Vent-Schmidt and Walid Abdelmagid
1:15 p.m. – 3:15 p.m.
IKBLC, Seminar Room

Developing a Learning-Centered Syllabus
Facilitators: Isabeau Iqbal and Manuel Dias
2:30 p.m. – 3:30 p.m.
IKBLC, Fraser Room

Looking for nursing faculty professional development resources?

Head over to Educating Nurses, an online portal featuring continuing education modules, learning activity guides, discussion trigger videos and articles by Dr. Patricia Benner, an eminent nursing educator and author who is also Professor Emerita at the University of California San Francisco School of Nursing.

Education modules are grouped into six themes: Entering the Practice of Nursing, Discussion Triggers, Novice to Mastery, Transforming Curriculum, Integrating Clinical Practice, and Making Large Classes Interactive. A list of videos in each module is listed in the image at the bottom of this article (click image to enlarge).

Access to resources at Educating Nurses is free to UBC SoN faculty, teaching assistants and graduate students, through a subscription paid for by this year’s EKM scholarship grant to Dr. Maura McPhee.

To create an account at Educating Nurses, use your UBC email address (name@nursing.ubc.ca or name@ubc.ca). If you have problems registering, please send an email to khristine.carino@ubc.ca.

Read the article here.

Flexible Learning in Nursing

By Michael Wong on June 30, 2015

As part of the flexible learning initiative, the UBC School of Nursing is implementing a hybrid approach to course delivery in the undergraduate curriculum. The hybrid approach links theoretical concepts and practice competencies by using a mixture of online content, in-class activities, and clinical practice. For Associate Professor Maura Macphee, one of the goals of the flexible learning approach has been to “operationalize the theory” in the clinical setting. “We created a hybrid model of education,” notes Maura. “Whatever we did online, [we wanted to] link it to classroom activities.”

The Bachelor of Science in Nursing is a 20 month accelerated undergraduate program, with 120 students per cohort. “Our program is the shortest in Canada,” states Maura. At the 2015 CTLT Spring Institute, Maura was joined by colleagues from the School of Nursing to share their experience and discuss how the hybrid approach is enhancing student learning, engagement, and satisfaction.

Ranjit Dhari and Joanne Ricci are the instructors for NURS 336: Professional Nursing Practice with Communities and Populations. They transformed their six-week course by using the flipped classroom approach.

In NURS 336, Ranjit and Joanne invite a number of guest speakers, who work in the profession, to share their expertise with the students. This provides a key link between the theory and clinical practice. However, Ranjit and Joanne have faced a number of challenges with bringing in guest speakers. “These experts are hard to get on a consistent basis,” explains Joanne. “When we would phone our partners in the community to be a guest speaker, they could help out maybe one or two times per year.” Unfortunately, this means that the same guest speakers are not available for each course offering. This adds some content variability across each six-week course.

Another challenge has been to make the content of the guest speakers available to all students. One solution has been to video tape the experts. “We decided to do a video. To video tape our guest speakers,” notes Ranjit. The guest speakers were videotaped in the Applied Science studio space, and Learning Technology Rovers helped edit the videos. The final videos were then uploaded to the Connect course site for all students to view.

After consulting the Centre for Teaching, Learning and Technology (CTLT) about the instructional design of the course, Ranjit and Joanne decided to shorten the length of the guest speaker videos. Ranjit notes that they were advised that students would not watch such a long video. “We looked at converting the one hour talking head and chunked it up,” she says. Ranjit and Joanne worked with the Learning Technology Rovers to edit the videos into shorter, more digestible segments, and organized the videos into the relevant population-based sections of the course.

At the end of each video, Ranjit and Joanne included embedded questions and recommendations. “We embed questions in their learning…so they can use this knowledge in the arena of public health,” says Joanne. “We looked at how can we make it interactive,” adds Ranjit.

Both Ranjit and Joanne acknowledged that the rapid pace of the course can lead to faculty burnout. “It is exhausting to do it every six weeks,” states Joanne. By having a break with the flipped classroom sessions, faculty are able to spend more time developing the course.

Joanne has also found it advantageous to move some of the in-class lecture time online, so that students can view the information at a time that is convenient for them. “It has been helpful to give them that flexibility,” she states.

Ranjit has noticed that students are making good use of the time that was normally dedicated to face-to-face lectures. She has found that students use the time to email her questions or book office hour appointments. Ranjit has also found that fewer students are needing extra time for their assignments. “I’ve gotten less requests for extensions,” she says.

Cathy Ebbehoj teaches NURS 333: Professional Nursing Practice with Childbearing Individuals and Families. Similar to Joanne and Ranjit, Cathy used a flipped classroom approach with her course.

Cathy developed the infant feeding section of the course into an online module in Connect. She feels that the infant feeding material is important, as students need a strong knowledge base of infant feeding prior to going into a clinical setting. “We intentionally looked at the sub-topics,” she notes. “We wanted to make sure we had a comprehensive view.”

Cathy pointed to the fact that many families want in-depth knowledge about infant feeding. As a result, Cathy would often accompany her PowerPoint slides with additional information. “I would [use] different resources for different students,” explains Cathy. For example, she would often include references to textbooks, YouTube videos, and other website resources in order for students to gain a better understanding of the material.

“Be prepared that there is going to be a fair amount of work,” says Cathy. “We found we had to be really intentional…we had to think in a whole different way.” As a result, Cathy used visuals and embedded videos to enrich the online course content. She also did voice-overs to help supplement some of the PowerPoint slides. “I tried to make sure that we broke it down for the students,” notes Cathy. “At the end of each subtopic, we had an assessment, a quiz…It helped solidify their knowledge.”

Cathy noted that she tries to help students think like a nurse. “The other thing we tried to do was to bring theory to practice,” she says. “We asked students to look at policies…and how they were employed in the hospital.” Cathy also tries to have the students draw on their own expertise and experience in order to bridge some of the gaps between the theory and clinical practice.

The second cohort of students is now using the online module, and Cathy has received positive feedback. “They [said that] the videos and external resources were really helpful,” she says. The content has been useful for students to refer to when they are in the clinical setting, and the added flexibility has been beneficial. “They really liked that they could complete the modules on their own time and at their own pace,” says Cathy. “They felt that they were better prepared to go into clinical.”

Cathy feels that the hybrid learning environment works well for her course. The mixture of face-to-face and online course content provides a good balance for the students. “I think that doing a mix is probably the right thing,” says Cathy. Student feedback indicates that while the students have enjoyed the flexibility of the online course content, they still like the face-to-face component and the ability to ask questions of the instructors.

Cheryl Segaric is the instructor for NURS 303: Introduction to Professional Nursing Practice with Adults, Older Adults, and their Families. There are three components to the eight credit course: theory, clinical practice, and clinical lab work. “The course is very high stakes for the students,” notes Cheryl.

Cheryl’s goal was to replace 12 hours of in-class content with online learning. This involved a lot of upfront work. “The workload was quite substantial initially,” she explains. However, Cheryl has found that the workload is beginning to ease off now that the course is in its third iteration.

For her course, Cheryl finds that the online learning environment allows for more participation, from more students. “With flexible learning, everyone gets to participate,” she states. “Everyone has to contribute.” Cheryl finds that with 120 students, not all of them can talk or participate in an in-class setting. By using online group discussions in Connect, she finds that all students are able to get involved. “It is more active and engaging,” she states. Cheryl has also noticed that the online contributions result in richer discussions, with more breadth and depth than in-class discussions. “It promotes a higher level of thinking,” exclaims Cheryl.

With her experience, Cheryl has found that students require guidance with the group discussions. “It is important to give very clear instructions,” she says. “Be clear about what students should be talking about.” Cheryl also advises other instructors to monitor the discussion boards. “You need to be monitoring those discussions,” she advises, “so they know that you are engaged with them…My TA has really helped with that.”

Students in NURS 303 also use the Canadian Neighbourhood Online Program. The online program includes a number of case studies, photos and medical charts, and patient profiles. It also has videos of conversations between a client and the physician. “It helps them really engage with the content,” states Cheryl. “It sort of personalizes it.” The physician and client interaction videos help students gain both the medical perspective and the client perspective. “It helps create a deeper understanding of the progressions of illness over time,” notes Cheryl.

By incorporating the Canadian Neighbourhood Online Program, Cheryl has noticed that the students are better able to make connections between theory and practice. “I am seeing some evidence that this is working to the benefit of the students,” she notes. With the online module, Cheryl finds that her students are able to break down what is happening, synthesize relevant information, and understand and apply that information to a particular case. “I can start to see that they are actually remembering [information], then moving to a level of understanding,” explains Cheryl. “They are taking the information and applying it to the case.”

All of the instructors expressed that the hybrid learning approach has proved to be very beneficial. “I think we made good progress with the online learning piece and active learning piece,” says Maura. Joanne pointed out that each instructor is implementing flexible learning in slightly different ways. “We are all doing it a little bit differently,” she noted. “It meets our course needs and the students’ needs.” The mixture of face-to-face and online learning has also worked well for Cheryl. “I like the blended [hybrid] learning piece,” she notes. “My take home message…is how valuable it’s been,” adds Cathy.

Maura concluded by acknowledging the collaborative effort that was involved in redesigning the courses. “We couldn’t have done it without support from CTLT, CIS [Centre for Instructional Support in the Faculty of Applied Science], and the LTRs [Learning Technology Rovers],” says Maura. “They were really supportive,” adds Cathy. “We couldn’t have asked for a better team.”

by Maura MacPhee

For our brown bag, we continued a discussion from the May 11th EKM workshop on practice competencies and indicators of particular importance for student transition from Term 1 to Term 2 of our accelerated program. There are a number of organizing frameworks for entry-level nursing practice competencies. The one attachment provides an overview of the domains/categories from the College of Registered Nurses of BC (CRNBC), the Canadian Association of Schools of Nursing (CASN), the US (BSN entry-level “wish list” from chief nursing officers across the US), and the Institute of Medicine (The Future of Nursing publication).

The categories from the Institute of Medicine were used as an organizing framework by Memorial University School of Nursing (MUNSON) in Newfoundland. MUNSON is a 24-month accelerated BSN program in Canada. See its website at: http://www.mun.ca/nursing/about_us/. We will discuss a published paper on the MUNSON curriculum re-visioning at our next brown bag.

For a summary of work from our May 11^th brown bag, click here. Participants in the May workshop selected specific competencies from our current student practice competencies that we believe are of most importance for beginning students (i.e., transitioning from Level 1 to Leel 2). The numbers in brackets alongside the competencies refer to how they are numbered and located within out student-practice faculty Practice electronic Portfolio (PeP). The PeP is an online portfolio with 21 competencies and numerous indicators per competency. The PeP has not been reviewed since 2007, and the 21 competencies and their accompanying indicators are not prioritized or leveled from term to term. The group needs to pick 2-3 indicators per competency to add to the assessment tool. We will eventually need to agree on categories/domains for PeP competencies and indicators: at present, we don’t have organizing domains or categories for our 21 competencies. Our discussion today was the beginning of a conversation to decide on what type of organizing framework we should adopt as we move forward with our own program’s re-visioning.

Our group will also need to decide on descriptors or a rubric to standardize how we give feedback to students. We currently used a Yes/No approach (yes they meet the competency or no they do not). We agreed during the workshop that we needed something with more specific, constructive feedback. Participants preferred the University of Melbourne 0-4 scale and the UBC clinical performance tool (March 9, Practice Education Advisory Group).

To summarize our practice competency assessment work group tasks to do:

1. Select domains/categories as an organizing framework
2. Add critical, measurable indicators to our Term 1-to-Term 2 core competencies
3. Select descriptors for student performance feedback

We will try to meet every 3-4 weeks over the summer to continue this project work.

A guest from Australia, Professor Patrick Crookes, will be visiting at the UBC School of Nursing on June 26^th from 9-11am. Professor Crookes is known for his work on a national Australian practice competency assessment framework known as the Nursing Competency Assessment Tool (NCAST). The NCAST is used by all Australian schools of nursing and nurse employers to assess entry-level competence for BSN-prepared nurses. Australia is also known for its professional development ladder that encourages ENs (enrolled or practical nurses) to obtain their BSN degrees; and BSN nurses to seek advanced educational preparation. Please join us for this session.

We reserved some time during our lunch hour brown bag to discuss changes to our nurse scopes of practice in BC. There are proposed changes (i.e., scope expansion) for LPNs, RNs and RPNs in BC. Our group briefly reviewed this document. I urge all nurse educators to be aware of the proposed changes that will influence what we include in our undergraduate curriculum. The document is at: http://www2.gov.bc.ca/gov/DownloadAsset?assetId=E51110C05BA04AF19120F8CA4681BC4C&filename=final_proposed_changes_to_the_nursing_regulations_mar_25_2015.pdf

I’d love to hear from others. Are these positive changes for our profession? Are they in line with regulatory trends outside BC? Outside Canada?

How has Flexible Learning been implemented at SoN?

Ask Maura MacPhee, Cathy Ebbehoj, Cheryl Segaric, Joanne Ricci and Ranjit Dhari—SoN Faculty– who were on centerstage at the recent annual UBC CTLT Institute.

Presenting to audience from various faculties across campus, our SoN faculty outlined the process of revising their courses to include FL, and shared lessons learned from that process.

Maura MacPhee provided an overview of the nursing undergraduate curriculum, funding of the SoN FL initiative through the UBC Teaching and Learning Enhancement Fund (TELF), as well as implementation and evaluation of SoN FL projects.

For Ranjit Dhari and Joanne Ricci, course leaders for N336 (Professional Nursing Practice with Communities and Populations), FL was a solution in addressing faculty burnout, challenges in guest speaker scheduling and course content variability across 6-week sessions. Focusing on two modules, Nutrition and Dental Public Health, they produced videos of  guest speakers and posted these online. Content was organized by population groups: 0-6 months, toddler-preschooler, school-age and adolescent. Guiding questions were embedded, and the “hour long talking head” was spliced into 15 minute video “chunks” for students to have a better viewing experience. Evaluation is currently ongoing, comparing student outcomes between the traditional class (homework, lecture, in-class discussion, questions on final exam) and the FL class (online modules with guiding questions, embedded questions, in-class case discussion and questions on final exam).

Cathy Ebbehoj, course leader for N333 (Professional Practice with Childbearing Individuals and Families) together with Farah Jetha, converted their Infant Feeding module. A slide show with lecture notes, curated videos, links to references and resources, embedded questions and a quiz were the main components of the online module. The course content was divided into five sub-topics that began with the overarching foundational knowledge providing  students the opportunity to experience the content through a global lens. Diagrams around the physiology of breastfeeding—and some additional notes—were included to provide students in-depth information which many families in the community currently expect to receive from health providers. At the end of each of the five sub-topics, an 8-10 question quiz was used to assess the students’ understanding of the material presented online. Students were required to obtain 80%, awarded 1 point for each sub-topic. Those who scored less than 80% after 3 attempts were given participatory points of 0.5 for that sub-topic. Online content was reinforced in discussions during the clinical and post-conference meetings. See the slides  for the challenges and joys which Cathy and Farah encountered in developing their FL module.

Cheryl Segaric, course leader for N303 (Introduction to Professional Nursing Practice with Adults, Older Adults, and their Families), was among the first instructors to implement Flexible Learning in the SoN. She replaced 12 hours of in-class content with online learning in Fall 2013.  The 3 main content areas “flipped” were: COPD (3 hours), Diabetes (3 hours), Stroke (3 hours) + 3 hours in leiu of workload. Cheryl is currently preparing for the third offering of the FL modules. Working with a large class of 120, Cheryl divided the students in 20 groups. The students reviewed online case studies using the  “Canadian Neighbourhood” (a virtual community) and responded to guided questions in a designated online group discussion forum. The groups then provided a summary at the end of the case. As a recap, students view a powerpoint presentation highlighting key points and complete an in-class quiz.

Even with a variety of minor challenges with technology, anecdotal feedback from Cheryl’s class has been mixed but generally positive. Cheryl continuously refines the modules for each offering and is looking into more formal evaluation of her FL modules, focusing on gathering evidence to support the belief that students are engaging with course content at a higher and more meaningful (applied) way. In the planning stage is also a research project which will examine the nature of learning using the Canadian Neighbourhood (online unfolding case study) and online discussion forum using guided questions. Check out lessons learned from Cheryl’s FL initiative here.

Date: May 12, 2015

Agenda:

1. Introductions/review of goals
2. Small groups: review and discuss well-known practice competency frameworks/rubrics
   1. Use flip charts to capture likes and dislikes of other frameworks/rubrics
   2. Report back to the large group
3. Small groups: identify practice competencies/indicators of critical importance for transition from Level 1 to Level 2
   1. Pick the “top 10” competencies*
   2. Pick 3-4 critical indicators per competency*
   3. Report back to the large group
4. Large group: Devise some preliminary recommendations for UPPC with respect to:
   1. PeP redesign
   2. Clinical site/lab assessment
   3. Next steps

Workshop goals:

1. By the end of the workshop, participants will determine if there are specific practice competencies and indicators that are essential/required for safe student transition from Level 1 to Level 2.
2. By the end of the workshop, participants will identify a competency framework and rubrics that are easy to use in clinical areas.
3. By the end of the workshop, participants will recommend potential PeP revisions for UPPC consideration.

Discussion notes:

1. How are we deciding the competencies?

2. What are the pros and cons of each tool?

By Maura MacPhee

The 3-day summit consisted of networking sessions, poster and podium presentations from US and international nurse educators, and key notes by well-known ‘stars,’ such as Chris Tanner and Pat Benner. The powerpoint slides are a potpourri of highlights from podium presentations on flipped and blended learning, clinical education engagement, concept-based education, and trends in healthcare education. What I found most notable from educator discussions: The broad acceptance of flexible learning (e.g., blended, flipped) and persistent challenges related to concept-based education. Most educators have comfortably converted to flexible approaches online, in class and labs and clinicals. Concept-based education, however, is requiring an overhaul of curriculum that is beyond the resources of many undergraduate programs and faculty.

This was an enlightening and inspiring conference-I highly recommend it. Next year, the educator summit will be in Nashville, same time in April 2016.

*Slide presentation available in pdf. Please send an email to khristine.carino@ubc.ca, for your copy. **Voice over slide presentation to be posted in the blog shortly.