OFFICE OF XYZ

1. OFFICE OF XYZ “The Shift” a Novel: Using Literature to Integrate QSEN Competencies into a Foundational BSN Nursing Course Barbara Patten MS, RN, CNE Danielle Walker PhD, RN, CNE Texas Christian University

2. Purpose • To explore integration of a novel, "The Shift," into concepts coursework to introduce QSEN competencies in a tangible manner to foundation level nursing students

3. Literary Pedagogy • Art, music, poetry, film, theatre, and literature have been incorporated into nursing education • Literature most widely utilized • Interpretive reading closely parallels clinical reasoning • Observation and interpretation Freeman and Bays, 2007

4. Using Literature Effectively • Careful selection of readings • Length • Institutional philosophy or curriculum • Student profile • Instructor Characteristics • Balance • Reading ad interpreting need to be part of a broader experience • Creation of conditions to maximize interpretation and contribution Sakalys, 2002; Stowe and Igo, 1996; Darbyshire, 1994

5. Evidence Based Outcomes of Literature Pedagogy • Seeing from the others perspective • Sensitivity to complexity of character or situation • Increased empathy and caring • Enriched ability to identify ethical care, advocate for patients, consider many possibilities of care • Development of reflection and reasoning skills • Clinical reasoning Brown, Kirpatrick, Mangum, Avery, 2008; Freeman and Bays, 2007; Butell, O’Donovan, Taylor, 204; Sakalys, 2002

6. Book Overview The Shift invites us to experience not just a day in the life of a nurse but all the life that happens in just one day on a hospital’s cancer ward.

7. Theresa Brown, RN • BSN from the University of Pittsburgh • PhD in English from the University of Chicago • Before becoming a nurse she taught English at Tufts University. • Her focus is medical oncology and end-of-life issues. • She lectures nationally, is a board member of the Center for Health Media and Policy at the Bellevue School of Nursing at Hunter College

8. QSEN Competencies in Foundations • Safety • Patient-Centered Care • Teamwork and Collaboration • Informatics • Evidence-Based Practice • Quality Improvement

9. Strategies implemented • Assigned to read the novel first of semester • Book to be completed by midterm • Assignments staggered throughout the semester. • Integrated throughout semester as related to concepts introduced

10. Assignments • Patient Safety • identify a potential or actual patient safety situation in the novel and actions (interventions) taken by nurse to prevent or resolve the situation • Interprofessional Communication • identify an interprofessional interaction that was a potential or actual conflict. Describe how the conflict was or was not resolved. • QSEN Competencies • identify Nurse Brown using each of the 6 QSEN competencies in her practice and briefly describe how

11. Assignments • Priority nursing problem identification • each of the 4 main patient characters with supporting data • Identify Nurse Brown’s priority patient • with rationale

12. Student Thoughts

13. Example: Patient Safety “One patient safety issue that Theresa Brown effectively identified and prevented was with her patient Mr. Hampton, who is a fall risk. Mr. Hampton is an older man who at the beginning of Theresa’s shift is confused and connected to oxygen. These three factors: age, confusion, and having oxygen tubing…a very high fall risk. Theresa Brown realizes this and immediately goes to his room to ask him if he needs to go to the bathroom. When he responds with yes, she helps him over to the side of the bed. By turning around but still maintaining her hand on his shoulder, Theresa ensures his privacy as well as safety. Then she helps him get back into bed. Through this she prevented a problem from occurring because had he woken up needing to go to the bathroom and gone without assistance, he easily could have fallen. By identifying her patient as a fall risk and intervening with one of the 5 P’s that nurses are supposed to check during hourly rounding, Theresa was able to evade a fall from Mr. Hampton.”

14. Example: Interprofessional Interaction “Actual/potential conflict: A potential conflict is during the conversation with Theresa and the young oncologist doctor. They are bantering back and forth about politics and then he asks her if she would get him a cup of coffee. Theresa starts to feel a little doctor vs. nurse in this situation and semi-jokes back, but there is obvious tension. “ “Prevention/resolution: Theresa jokes back, but in a way that makes it known that her purpose is not to get him coffee. This ends the banter between the two and they shift back to “work mode.” She handled the situation well because she could tell he was joking, but she held her own. However, the circumstances would have been very different if he had not been joking, and it would have most likely lead to some type of conflict.”

15. Example: Patient Centered Care “When Sheila becomes distressed when Peter tells her that she might not survive the operation, Theresa holds her hand to tell her exactly what is going to happen. Sheila requests a pastor, so Theresa goes out of her way to get a pastor to go speak with Sheila. Theresa emphasizes to Sheila to tell her when she is in pain so she can give her pain medications when she is and to tell her as soon as possible to prevent high levels of pain.”

16. Example: Quality Improvement “As a result of dangerous errors in the past where patients received the wrong type of blood, the hospital enforced a policy for blood-typing that ensured the blood types were correctly matched. The policy involves drawing two tubes of blood immediately and then one tube 30 minutes later. If all of the tubes and blood types matched, it was clear that the blood was from the same person. This hospital protocol was discussed when Sheila needed to get her blood type tested before surgery.”

17. Candace Moore experienced anxiety related to her autologous transplant as evidence by distrust of nurses, aggressive demeanor, paranoia, and her obsession with cleanliness due to her impaired immune system. (pg 82) • Sheila Field: • Acute Pain R/T bowel perforation • She tells Theresa Brown that her “belly hurts” (Brown, 2015, p. 44) • Her BP is high, 160/100 specifically, and BP often rises in response to pain • She’s crying and has visible tears (Brown, 2015, p. 111) • She is taking Dilaudid, a very strong pain medication, and not controlling pain  Example: Prioritization Candace Moore experienced anxiety related to her autologous transplant as evidence by distrust of nurses, aggressive demeanor, paranoia, and her obsession with cleanliness due to her impaired immune system. (pg 82) Sheila Field: • Acute Pain R/T bowel perforation • She tells Theresa Brown that her “belly hurts” (Brown, 2015, p. 44) • Her BP is high, 160/100 specifically, and BP often rises in response to pain • She’s crying and has visible tears (Brown, 2015, p. 111) • She is taking Dilaudid, a very strong pain medication, and not controlling pain   

18. Student Outcomes • Increased ability to define and apply each competency. • Words were no longer foreign to students • Students are able to build on the knowledge, skills, and attitudes in the clinical setting. • QI and EBP were definable but had difficulty applying concepts to Nurse Brown's practice. • Better grasp of critical thinking and clinical reasoning skills • Including prioritizing and questioning • Discussion and application of Nurse Brown's fictional practice by students in other concurrent courses.

19. Student Perspective of Using “The Shift” • Positive Aspects • Like the book; it gives better idea of nurse’s role • Can relate book to clinical • Appreciate a grade that is not an exam • Sharing the book with faculty in other courses • More open to novels introduced in future courses. • Negative Aspects • View as additional “to dos”/assignments • “Not a writing class” • “Not real life”; it’s fiction • Trying to do too many different activities in course

20. Faculty Perspective of Using “The Shift” • Positive Aspects • Ready “case study” to relate concepts to when introduced • Created better understanding of “real life” as nurse for students • Gives insight into where students are at throughout semester; can see growth • Assisted in assessment and evaluation • Facilitated participation grading in a concepts course • Negative Aspects • Assignments are time consuming to grade • Too early in curriculum for some competencies: QI and EBP • Keeping the assignments unique from semester to semester • Will always be negative feedback from some students • Implemented at same time as new curriculum and new technologies (ExamSoft; ATI activities; EHR tutor)

21. Moving Forward • Purposely evaluate knowledge of QSEN competencies Pre/Post use of Shift novel • Further integrate book into course • ongoing case study • Consider using the book in future courses across curriculum • Use as way to launch a “Safety Culture” in program

22. References • Brown, S. T., Kirkpatrick, M. K., Mangum, D., & Avery, J. (2008). A review of narrative pedagogy strategies to transform traditional nursing education. Journal of Nursing Education, 47(6), 283-286. doi:10.3928/01484834-20080601-01 • Brown, T. (2015). The shift: one nurse, twelve hours, four patients' lives. First edition. Chapel Hill, North Carolina: Algonquin Books of Chapel Hill. • Butell, S. S., O'Donovan, P., & Taylor, J. D. (2004). Educational innovations. Instilling the value of reading literature through student-led book discussion groups. Journal of Nursing Education, 43(1), 40-44. • Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. doi:10.1016/j.outlook.2007.02.006 • Sakalys, J. A. (2002). Literary pedagogy in nursing: a theory-based perspective. Journal of Nursing Education, 41(9), 386-392. • Stowe, A. C., & Igo, L. C. (1996). Learning from literature. Novels, plays, short stories, and poems in nursing education. Nurse Educator, 21(5), 16-19. • Freeman, L. H., & Bays, C. (2007). Using Literature and the Arts to Teach Nursing. International Journal of Nursing Education Scholarship, 4(1), 15. doi:10.2202/1548-923X.1377

23. Contact Information • Barb Patten • B.a.patten@tcu.edu • Danielle Walker • D.k.walker@tcu.edu

24. Questions?