Developing a Profession Specific Statistics Course for Nurses

1. Developing a Profession Specific Statistics Course for Nurses Jane Oppenlander School of Management The Bioethics Program Union Graduate College eCOTS, May 19-23, 2014 1

2. Evidence-based Nursing Practice • Evidence-based practice (EBP) is an approach to nursing practice that makes use of the best evidence in making clinical decisions about patient care • Steps in the EBP process • Formulate a clinical question • Gather and critically appraise the best evidence • Integrate evidence with clinician expertise, patient condition and preferences and healthcare resources • Evaluate the practice change as a result of implementing the evidence • To meet the needs of practicing nurses, a graduate-level statistics course was designed covering traditional introductory statistics content with a healthy dose of research methodology and biostatistics 2

3. The Students and Their Motivation • The students were experienced nurses: • Hospital administrators, floor nurses, nursing school faculty • Both bachelor’s and master’s prepared in nursing • Leading the implementation of evidence-based practice in their institution • Some pursuing advanced degrees • The nurses: • Valued the importance and role of statistics and research to achieve efficient healthcare delivery and quality patient care • Were dissatisfied with prior statistics courses, particularly on-line • Lacked confidence in their statistical capabilities • Were motivated to learn and wanted a classroom setting • Matthew et al (2013) report graduate nursing students have significantly poorer attitudes toward statistics than undergraduate nursing and non-nursing majors based on the SATS-36 survey 3

4. Preparing to Design the Curriculum • Investigate the nursing profession to make course relevant: • What is important to nurses? To their success? • What kinds of problems do they encounter? • Where are statistical studies used and needed? • Where do they get their data? • How and where do they report their findings? • Consulted practicing nurses, nursing professors and researcher, and local healthcare professional organizations • Goal: • Create a graduate level statistics course where nurses can develop competence and confidence in applying statistics to the problems they encounter in their practice 4

5. Emphasize Statistical Literacy and Thinking • Build statistical literacy by reading, writing and presenting statistical results • Examine abstracts to identify the important and essential statistical concepts • Read and summarize nursing research articles chosen by the students • All student learning assessments are the evaluation of written reports or oral presentations of the type they would be expected to produce in their profession • Statistical thinking is a shift from nurses’ intuition • Collect data from a survey, an operating process, and a design experiment • Evaluate the variability in the collected data graphically and numerically, addressing outlying observations • Examine in detail a published article whose focus is to quantify the variability in the cost of hip replacement (Rosenthal et al, JAMA Internal Medicine, Feb. 11, 2013) 5

6. Use Real Data • There is an abundance of healthcare data available on the Internet • Federal (data.medicare.gov) and state (e.g., health.data.ny.gov) websites • Hospital acquired conditions are of interest to nurses • Falls, pressure ulcers, certain infections • Data used in the course: • Hospital acquired conditions from regional hospitals for assignments and classroom activities chosen by instructor • Contributed by students from nursing research and quality improvement studies in their hospital • Collected by students for class assignments • Obtained by students from the Internet for final project 6

7. Stress Conceptual Understanding • Research Process • Types of health studies – cohort, randomized controlled trials • Difference between research and quality improvement studies • Design principles – randomization, blinding, balance • Levels of measurement • Principles and issues survey design • Statistics • Descriptive statistics and effective data presentation • Basics of statistical inference • Hypothesis testing, confidence intervals, p-values, statistical vs. clinical significance • Measure of disease frequency and risk • Odds ratio, relative risk, prevalence, incidence, … • Sample size, power analysis, and effect size • Comparative analysis • 2 sample t-tests, ANOVA, Chi-squared tests of association • Simple regression analysis and correlation 7

8. Foster Active Learning • Classes are conducted in a workshop fashion • Driven by relevant nursing or healthcare problems • Students frequently work in small groups solving problems and present their results to the class for discussion • Ample time allowed for discussion of how the statistical techniques could be applied in their practice setting • Two of the datasets examined by the class came from students’ nursing practice • Student learning assessments • Focused on either actively producing (and analyzing) data or consuming statistical analysis • In many of the assessments, students choose the problem and data to be addressed, but not the form or length of the written product 8

9. Use Assessments to Evaluate Learning • Conduct an at-home experiment • Develop and pilot a survey • Data collection from a process daily for 30 days • Journal article summary in lay language • Final project – empirical research project • Problem formulation, literature search, find data, analyze and interpret results • 1 page project proposal, 3 page paper and 15 minute in-class presentation • Students evaluate presentations and provide feedback 9

10. Use Technology • All software used was chosen because it was available to students in their workplace • Excel with Data Analysis Add-in • Underestimated students’ Excel capabilities. Required preparation of examples, templates, and how-to guides • On-line calculators • Sample size determination • Power analysis • Statistical methods not available through Excel Data Analysis Add-in (www.vassarstats.net) • SurveyMonkey • Audio and Video • 200 countries, 200 years in 4 minutes • NPR All Things Considered segments on health care studies 10

11. Lessons Learned • Make everything relevant to their profession • Topics covered, cases, problems, and data used • Be willing to learn from your students about their profession as they learn about statistics from you • Working in small groups solving problems was particularly effective • Developing confidence is as important as developing competence to produce workplace advocates for evidence-based practice • Organize material into self-contained modules so it can be reused in professional development settings such as short courses, seminars, etc. • Seek feedback from students periodically throughout the course 11