Graduate Curricula in NursingNURS 212October 18, 2006

Phyllis M. Connolly PhD, APRN-BC, CNS

Professor, School of Nursing

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

“To be active participants in shaping the health care system, nurses

must learn new skills”

Alderman (2001, p. 50)

Questions to Consider What role does history play in

graduate nursing education? What are the major differences

between the undergraduate, graduate and doctoral curricula?

What are the significant internal and external factors affecting the development of graduate nursing programs?

What are some outcome measures of graduate nursing education?

Critical Elements Affecting Graduate Nursing Education History

Role of women in society

Societal needs War Military Industrialization Technology Immigration

Legislation Nurse Practice Acts Medicare

National Policy Third-party

reimbursement Inter and Intra

Professional Organization Standards Certification

Initial Graduate Education

1920s Case Western Reserve 1923 Yale University (Gold Mark Report &

Rockefeller Foundation) Education Administration

World War II 1945 to 1970s Nurse educators Administrators Clinical nurse specialist Nurse practitioners

History of Advanced Practice Nurses: Nurse Anesthetist Nurse anesthesia mid 1800s Today CRNA Sister Mary Bernard, St. Vincent’s Hospital in Erie,

PA 1877; formed a network of hospitals “Mayo Clinic” Alice Magaw by 1906 over 14,000 surgical cases—no deaths. Specialized field require education and moved away from nursing administrative structures.

Greatly influenced by American military and major wars 1945 AANA initiated certification program

1999 28,000 CRNA in US 1973 University of Hawaii, first master’s degree

program, nurse anesthetist

Clinical Nurse Specialist Responding to improving quality of nursing

care Directors of Graduate programs responded 1954 1st CNS, Dr. Peplau 1954, Rutgers Influenced by National Mental Health Act

1946, psychiatric nursing a core discipline Funding

Autonomous practice, 3rd party payment

Nurse Practitioners 1971 Idaho 1st state to authorize the

expanded role controlled by Board of Nursing and Medicine Controversy over prescriptive authority

Loretta Ford, 1965, Colorado 1st Pediatric NP program, certificate; 4 months intensive then 20 months training and practice

1990 over 135 masters programs; 40 certificate

1998 over 750 masters and 12 certificate

Nursing Education Baccalaureate Doctorate

BSN Master’s Doctorate

Research Read & Evaluate

Evidence based; evaluate use & do

Develop theories; models; tools; conduct

Programs Generic; accelerated; RN to BSN

MS; MSN; MS/MBACertifications

PhD; EdD; DNSc;DNP

Accreditation

BRN;CCNE;NLN; WASC

BRN; CCNE; NLN;NONPF;WASC

WASC

Model of Master’s Nursing Curriculum

Graduate Nursing Core

AdministrationAPN Clinical CoreCommunity Health

Specialty CurriculaCNM CRNA NP CNS School Nurse CNS*

Primary Care NP Acute NP

Educator*

Graduate Nursing Core

P. M. Connolly 2006* Not part of AACN Essentials Model

CRNAs 30,386 86.7 84.4

CNMs 6,534 81.7 87.9

CNSs: Psy PeplauRutgers 1954

53,799 90.5 23.6

NPsFord, Colorado 1965

63,191 88.2 63.5

CNS/NPs 7,802 100 70.9

NCMs NO DATA NO DATA NO DATA

Number of Advanced Practice Nurses in the US March 1996TITLE

TOTAL NUMBER

% CURRENTLY IN NURSING

% NATIONALLY CERTIFIED

Hamric, Spross, & Hanson, 2000, p. 7

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

Leader

Core Curriculum

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

Curriculum Core Courses: 14 Units, SJSU

NURS 200 Health Care Systems, 3 Units

NURS 202 Theoretical Foundations, 2 units

NURS 204 Diverse Populations and Health Care, 3 units

NURS 295 Research Design, 3 units

NURS 297 Seminar Project or Thesis, 1 unit NURS 297 Project or Thesis, 2 units

Advanced Practice Curriculum Advanced health assessment Pharmacology Physiology Advanced patho/physiologyCore Specialty Practice

Anesthesia Nurse Practitioner Clinical Nurse Specialist Nurse Midwife School Nurse

Nurse Educator Nurse Administrator

Family Nurse Practitioner30 Units

NURS 248 Adv. Health Asses, 3 units*

NURS 250, FNP Theory I, 2 units*

NURS 252, FNP Theory II, 2 units*

NURS 253, FNP Practicum I, 5 units*

NURS 254, FNP Practicum II, 5 units*

NURS 256, FNP Practicum III, 5 units*

NURS 258, FNP Professional Issues, 2 units*

NURS 259 Advanced Pharmacology, 3 units; Dominquez Hills, online

NURS 260 Advanced patho/physiology, Dominquez Hills, online*Special

Session Fees

School Nurse Clinical Specialist & Credential

NURS 206, 3 units, Advance Health Assessment

NURS 270, 3 units, School Nursing Pathophysiology & Pharmacology

NURS 272, 5 units, School Nursing I: Clinical Nurse Specialist (CNS)

NURS 274, 5 units, School Nursing II: CNS

2 Education supporting courses, 3 units each

Nurse Administrator

NURS 246 Modern Organizations & Health Care, 3 units

NURS 236A Nursing Adm. Theories, & Practicum I, 3 units

NURS 236B, Nursing Adm. Theories, & Practicum, II, 4 units

NURS 266 Health Care Informatics

BUS 220 Accounting Principles, 3 units

BUS 285 Total Quality Management, 3 units

BUS 286 Project Management, 3 units

Special Moore Foundation: MS & Post-MS Certificate

Educator Track 16 months; Cohort II Fall 06 completion December 2007

Funded with forgivable loans All Special Session fees Stipends available ($20,000) Must attend Teacher/Scholar monthly seminars MS must agree to teach full-time for 3 yrs.

in any RN program in Alameda, Marin, Santa Clara, San Francisco or San Mateo Counties

Post MS certificate agree to teach full-time for 1 yr in any RN program in 5 Counties

Nurse Educator Option22 Units

NURS 212 Curriculum Design, 3 units

NURS 214 Nursing Education Theory & Practicum I, 5 units (240 hrs clinical)

NURS 216 Nursing Education Theory & Practicum II, 5 units (240 hrs. clinical)

NURS 208 Special Topics (20 clinical hrs.) or EDIT 272, Distance Education

NURS 266 Health Care Informatics on-line course, 3 units*

EDIT 186 Instructional Media/ 3 units; blended online and in person

IOM Rules for Redesign (2001)

Care is based on continuous healing relationships

Care is customized according to patient needs & values

The patient is the source of control Knowledge is shared & information

flows freely Decision making is evidence-based

AACN: Role New Clinical Nurse Leader 2005

Leadership in care of sick across all environments

Design and provision of health promotion and risk reduction services for diverse populations

Provision of evidence-based practice Population-based health care to

individuals, clinical populations & communities

AACN: Role New Clinical Nurse Leader Leadership in care of sick across all

environments Design and provision of health

promotion and risk reduction services for diverse populations

Provision of evidence-based practice Population-based health care to

individuals, clinical populations & communities

Driving Forces Program Evaluation

Commission on collegiate Nursing Education (CCNE)

NONPF BRN WASC University Review Policy

WASC One of 6 regional accrediting

associations Voluntary, non-governmental Purpose to foster education

excellence Institution must define quality &

excellence File annual report Visit with self-study every 5

years Nine standards

Theoretical Frameworks for Evaluation

Total Quality Management Continuous Improvement Donabedian’s Model

Structure Process Outcome

Employers’ Needs

Program Evaluation and Research Committee10/97 Rev/ 4/99Approved 2/12/01

 

UNIVERSITY MISSION

CURRICULUM

ALTERNATIVE PROGRAMS LOCATIONS, CONTROLS, AND MONEY

PROGRAM FEEDBACK

GENERAL PUBLIC FEEDBACK

PUBLIC FEEDBACK OF EXPLICIT OBJECTIVES, MEANS, AND COSTS

SCHOOL OF NURSINGTotal Program Evaluation Model

 

BSN

SCHOOL NURSE

RN to BSN

FNP

 

SCHOOL’S MISSION & PROGRAM EVAULATION PLAN

Program Outcomes

Society’s Values

Curriculum

BSN MS

RN to BSN FNP SNCred

CCNE 2001 Standards I. Program Quality:

Mission/governance II. Program Quality: Institutional

Commitment & Resources IIII. Program Quality: Curriculum &

Teaching-Learning Practices IV. Program Effectiveness, Student Performance & Faculty Accomplishments

Process

Semester Curriculum Meetings Course Reviews

Curriculum Committee Curriculum review

Task Force Reviews end of semester

Standing Committees Faculty Meetings

School of Nursing Program Evaluation & Feedback System: On Going Systematic

Evaluation Full Faculty

Meet Monthly

Curriculum Coordinating CommitteeMeet Monthly

Represents All Semesters

Program Evaluation & Research CommitteeMeet Monthly

Report: NCLEX, BSN Exam, Grad Rates,Employment Patterns, Demographics, Course Satisfaction

Semester Level Curriculum CommitteesMeet Monthly

Represents all Faculty Teaching in Semester

Continuous Improvement Task ForcesMeet End Each Semester

Continuous Improvement Task ForcesGerontology

Adult; CommunityPsych/Mental Health

GraduateSemesters 3 - 8

BridgeMeet Monthly

Student Representatives

RecommendationsTo

Curriculum Coordinating Committee

TheoryProcess

SkillsPracticum

RecommendationsTo

Curriculum Coordinating Committee

BRN Content ExpertsSpecialization ExpertsAcross the Curriculum

Review & Make RecommendationsBased on Results ofStandardized tests

RecommendationsTo

Curriculum Coordinating Committee

Masters SON Outcomes “Implement care management,

including but not limited to case management, resource management, advocacy, and outcome evaluation;”

Apply critical thinking and ethical decision making including the use of the nursing and research processes;”

Program Outcomes

Incorporating systems theory concepts, ANA Social Policy Statement (1995), relevant ANA Standards of Care, AACN Essentials for Master’s Education for Advanced Practice Nursing (1996),National Organization of Nurse Practitioner Faculties (NONPF); and the California Board of Nursing, the master’s nursing graduate will:

apply critical thinking and ethical decision-making including the use of the nursing and research processes;

provide theory and research-based culturally competent, safe therapeutic nursing interventions for clients in advanced nursing practice;

employ advanced interpersonal skills in professional relationships with clients, families/caregivers, and multidisciplinary health care team members;

support health promotion and disease prevention activities in developing and monitoring holistic plans of care for well and at-risk clients, considering access, quality and cost;

Program Outcomes Cont.

demonstrate the collaborative and leadership skills required in advanced nursing practice within a multidisciplinary and multicultural (community) health care context;

plan, implement, and evaluate advanced nursing practice that promotes and preserves health and healthy lifestyles of individual clients and aggregates;

plan, implement, and evaluate advanced therapeutic nursing practice in a rapidly changing, multicultural health care environment;

implement care management, including but not limited to case management, resource management, advocacy, and outcome evaluation;

employ information technology in advanced nursing practice to evaluate and improve heath care delivery and outcomes;

actualize the advanced nursing practice role by incorporating professional standards, ethical guidelines, legal mandates, and professional activities.

Graduate Publications Beddoe, A., & Murphy, S.O. (2004). Does mindfulness

decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43, 305-312.

Litarowsky, J., Murphy, S., & Canham, D. (2004).Evaluation of an anaphylaxis training program for unlicensed assistive personnel. Journal of School Nursing, 20(4), 57 -62.

Moody, P. Gonzales, I., & Cureton Young, V. (2004). The effect of body position and mattress type on interface pressure in quadriplegic adults: A pilot study. Dermatology Nursing, 16(6), 507 – 512.

Ngoh Toche, C., Lewis Daniels, I. & Connolly, P. M. (2005). Outcomes of inpatient geropsychiatric treatment. Journal of Gerontological Nursing, 31(4), 12 -18.

“Advancing knowledge to improve health of the

world’s people”