Post BSN DNP and Post MSN DNP Programs Making the Recommendations Real

1. Post BSN DNP and Post MSN DNP ProgramsMaking the Recommendations Real  Dr. Diane Wink Dr. Susan ChaseDr. Christopher Blackwell College of Nursing

2. Post BSN DNP and Post MSN DNP Making the Recommendations Real Objectives • Describe a post BSN NP curriculum that allows achievement of NP core competencies for the non NP and DNP outcome objectives for both the novice and expert NP completing only post MSN coursework. • Use a scaffolding learning approach to develop courses that help students develop core skills needed to achieve cognitive and clinical skill program objectives.

3. Post BSN DNP and Post MSN DNP Making the Recommendations Real Greeting’s from the University of Central Florida College of Nursing

4. Post BSN DNP and Post MSN DNP Making the Recommendations Real Outline • Post BSN DNP Curriculum for Non Nurse Practitioners – Dr. Wink • Scaffolding Approaches to Post BSN DNP Curriculum – Dr. Wink • Post MSN DNP Curriculum – Dr. Blackwell • Lessons Learned from the Development, Implementation and Outcomes of a DNP Program – Dr. Chase

5. Part 1: Post BSN DNP Curriculum for Non Nurse Practitioners Dr. Diane Wink EdD, FNP-BC, ARNP, FAANP Professor, UCF College of Nursing Coordinator Family and Adult NP tracks

6. Post BSN DNP Curriculum for Non Nurse Practitioners Foundations for curricular design Curricula must develop knowledge and skills (clinical and cognitive) traditionally addressed in the MSN curriculum as well as the additional outcomes for the DNP. • Macro curricular design • Essentials and competencies • Course content alignment and sequencing • Micro curricular design • Development and inclusion of focused assignments

7. Post BSN DNP Curriculum for Non Nurse Practitioners Foundations for curricular design • 2015 – What are we being asked to do? • Post BSN NP DNP students, how they are different? • NP DNP curriculum to meet professional recommendations and future needs • DNP skill Development • Developing cognitive and clinical skills using a scaffolding learning approach

8. Post BSN DNP Curriculum for Non Nurse Practitioners Curriculum Review: • Adult-Gerontolical Primary Care Nurse Practitioner Competencies (2010) • Consensus Model for APRN Regulation (2008) • Criteria for Evaluation of Nurse Practitioner Programs: Report of the National Task Force on Quality Nurse Practitioner Education Programs (2008) • Practice Doctorate Nurse Practitioner Entry Level Competencies (2006) • Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health (2002)

9. Post BSN DNP: Curriculum Review and Design Foundations for curricular design Problems Identified: • Gerontology Content • Clinical Practice Course hours • At minimal level for MSN • Needed 1000 hours to meet DNP criteria • Specific content areas (e.g. in health promotion) needed more depth and scope • Selected psychomotor sills (e.g. suturing, biopsy) needed enhancement

10. Post BSN DNP: Curriculum Review and Design Core Courses Maintained “As is:” • Theory for APN • Research Methods APN • Advanced Health Assessment and Diagnostic Reasoning • Advanced Pathophysiology • Health Promotion

11. Post BSN DNP: Curriculum Review and Design Added Course: • Gerontology • Gerontology Clinical Practice Course

12. Post BSN DNP: Curriculum Review and Design Changes in Existing Core courses: • Evidence Based Practice • Statement about eventual project • Cultural and Legal, Health Care Systems, Professional Obligations & Activities in APN -> • Legal and Professional Behavior in APN • Pharmacology -> • More pharmacodynamics, pharmacokinetics, principles of safe prescribing, pharmacology issues • In NP classes • Continued review of pharmacodynamics, pharmacokinetics major drug classes • Application of pharmacologic principles in the clinical context in NP focused courses

13. Post BSN DNP: Curriculum Review and Design Changes in Existing NP Core Courses: • Adult 1 and its clinical • Adult 2 and its clinical • Pediatrics and its clinical • Womens Health and its clinical -> • Gender Related with Women’s health Clinical • Clinical Practicum

14. Post BSN DNP: Curriculum Review and Design “DNP Courses” Developing leadership skills to meet DNP competencies • Nurse Leadership/Management • Nursing Care Environment Management • Healthcare System Policy Expanded Practice as a DNP • Epidemiology • Concepts, Measurement and Data Management • Advanced Clinical Management for the NPN • Advanced Clinical Practice Selective for ANP (clinical course) • DNP Residency (two courses) • DNP Project (two courses)

15. Post BSN DNP: Curriculum Review and Design Issues, Problems and Solutions • Could move into DNP practice with little NP experience • Clinical practice hours pre MSN increased from 530 to 630 • Desire for MSN and certification and start in NP practice • MSN along the way

16. Post BSN DNP: Curriculum Review and Design Issues, Problems and Solutions • Desirability for certification and start in NP practice • MSN along the way • Start working as NP while finishing DNP • Could move into DNP Project stage with little NP experience • Assignments to build to DNP project • Links to sample Full and Part Time Plans of Study for the UCF College of Nursing post BSN DNP curriculum can be found at: http://www.nursing.ucf.edu/academics/BSN-DNP.asp

17. Part 2: Scaffolding Approaches for Post BSN DNP Curriculum Dr. Diane Wink EdD, FNP-BC, ARNP, FAANP Professor, UCF College of Nursing Coordinator Family and Adult NP tracks

18. Scaffolding Approaches for Post BSN DNP Curriculum General Considerations: • Competencies of students on entry • Novice to expert progression not expert to novice back to expert progression of many post MSN DNP students • Need for strong clinical and cognitive foundation for future practice as a DNP prepared NP • DNP targeted classroom and clinical experiences • Eye on the goal! • Words do matter!

19. Scaffolding Approaches for Post BSN DNP Curriculum Principles of scaffolding in education: • Early in learning experience students need a great deal of support • Provide activities calling for skills just beyond what the learner can do • Can accomplish do future activities based on this new knowledge and skill • Support includes • How learning organized • Way students helped to recall and use prior knowledge • Reading and other activities with the learning • Guide to how to use new knowledge or use new skill (Eduplace (1997); http://www.eduplace.com/rdg/res/literacy/lit_ins4.html)

20. Scaffolding Approaches for Post BSN DNP Curriculum Goals: • Build on and expand ability to use knowledge from • BSN education • Ongoing DNP courses and clinical practice • Move on to • Quality DNP project on topic relevant to DNP practice • Quality DNP practice in which the DNP role competencies demonstrated • http://www.osha.gov/SLTC/scaffolding/scaffold_slides/scaffold_01.html

21. Scaffolding Approaches for Post BSN DNP Curriculum Requirements for Success: • Appropriately sequenced courses • Faculty collaboration • Ongoing staff discussion about • Curriculum and courses • How the curriculum is an integrated whole • Skill development in one course to prepare for the next step • Theory -> Research -> NP Core -> NP classes -> Evidence Based Practice Paper -> DNP Project • Assignments crafted to direct students to think of the next step

22. Scaffolding Approaches for Post BSN DNP Curriculum Examples: • Pharmacology • Basic Principles -> Application to clinical situations in context which considers individual client • Theory -> Research -> Evidence Based Practice Paper -> DNP Project • Activities in NP courses • On-line post conferences • Supports EBP course and future project a • Adult 1 and Gerontology Courses • Examination of EBP documents • Service Learning Project • Adult 2, Pediatrics, Gender Related Courses • PICO question activity

23. On Line Post Conferences All Clinical Courses • Clinicals which are not all at one location or time • Promotes interaction • Captures clinical experiences which could be lost • Allows faculty and peer feedback

24. Adult 1 and Gerontology Courses: EBP Assignment Objectives: • Examine source of EBP Practice Guidelines • Analyze issues related to guidelines development • Examine the levels of evidence used • Identify needed guideline updates • Present and discuss any disputes and/or issues Preparation needed for assignment: • What are levels of evidence • What a practice guidelines is Expected outcomes: • Application of principles learned in Theory and Research • Preparation for Evidence Based Practice Paper; • Possible foundation for future DNP project

25. Adult 1 and Gerontology Courses: Service Learning Project Objectives: • Identify a community based issue/problem • Collaborate with community partner • Review of the literature on issues r/t project • Complete community/ agency assessment • Analyze assessment data • Implement (design, carry out, evaluate) project • Formally report outcomes: written report and poster Sample Projects: • Health Promotion program for local county government • Evaluation of heart failure program outcomes • Promotion of breastfeeding friendly workplaces

26. Adult 1 and Gerontology Courses: Service Learning Project Preparation needed: • From BSN program: How to do a community assessment; collaboration with community members; sources and influences on health behaviors and outcomes beyond provider/ client interaction Expected Outcome: • Ability to review literature, analyze data • Work collaboratively with individuals and agency representatives • Plan, implement and evaluate project • Present outcomes in formal manner. • Possible foundation for future DNP project

27. Adult 2, Pediatrics, Gender Related Courses: PICO Project Preparation needed: • From BSN program, How to do a community assessment, collaboration with community members, sources and influences on health behaviors and outcomes beyond provider/client interaction. Expected Outcome • Ability to review literature, analyze data • Work collaboratively with individuals and agency representatives • Plan, implement and evaluate project • Present outcomes in formal manner • Possible foundation for future DNP project

28. Adult 2, Pediatrics, Gender Related Courses: PICO Project Sample Project: • Examine evidence related to the use of lubricants when doing diagnostic (e.g. thin prep) gynecologic examinations. Preparation needed: • Ability to do a good quality literature search • Ability to identify actual or potential EBP standard deviation Expected Outcome: • Increased ability to search, retrieve and review research and EBP literature. • Increased level of preparation for EBP project • Possible foundation for future DNP project http:://www.olsoncenter.com/home/index.php?option=com_content&task=view&id=7&Itemid=11

29. Part 3: Scaffolding Approaches to Post MSN DNP Curriculum Dr. Christopher Blackwell PhD, ANP-BC, ARNP. CNE Assistant Professor, UCF College of Nursing

30. Scaffolding Approaches for Post MSN DNP Curriculum General Considerations: • Varied levels of Expertise as an Advanced practice Nurse • Clinical background • ANP preparation • Years in practice • Involvement in clinical practice organizations • Involvement in health care issues and policy initiatives • Routine use of EBP in practice • Exposure to scholarly documents Can not assume all NPs have strong clinical and cognitive foundation for future practice as a DNP prepared NP

31. Scaffolding Approaches for Post MSN DNP Curriculum Goals: • Build on and expand ability to use knowledge from • Practice as an Advanced Practice nurse (NP) • MSN education • Move on to • Quality DNP project on topic relevant to DNP practice • Quality DNP practice in which the DNP role competencies demonstrated

32. Scaffolding Approaches for Post MSN DNP Curriculum Requirements for Success: • Appropriately sequenced courses • Faculty collaboration • Ongoing staff discussion about • Curriculum and courses • How the curriculum is an integrated whole • Skill development in one course to prepare for the next step • MSN and NP Foundation -> Evidence Based Practice Paper -> DNP coursework ->DNP Project • Assignments crafted to direct students to think of the next step

33. Revisions to Accommodate Post BSN Students in DNP Courses • Deletion of pure PhD courses in DNP curriculum • New course which combined content from PhD Concepts and Research Courses to single course which addresses data generation/ analysis and analysis • Addition of EBP practice course to “refresh” student’s knowledge and skills in • Identification of scholarly materials • Completion of a scholarly writing project • Addition of up to three electives to allow focus on content relevant to goals of practicing NP in DNP program

34. Revisions to Accommodate Post BSN Students in DNP Courses Continuation of courses in: • Nurse Leadership/Management • Nursing Care Environment Management • Epidemiology • Concepts, Measurement and Data Management • Healthcare System Policy • Advanced Clinical Management for the APN • Advanced Clinical Practice Selective for ANP (clinical course) • DNP Residency (two courses) • DNP Project (two courses)

35. Core DNP Courses Developing leadership skills to meet DNP competencies • Nurse Leadership/Management • Nursing Care Environment Management • Healthcare System Policy Expanded Practice as a DNP: • Epidemiology • Concepts, Measurement and Data Management • Advanced Clinical Management for the APN • Advanced Clinical Practice Selective for ANP • DNP Residency (two courses) • DNP Project (two courses)

36. DNP Course Exemplars Epidemiology • Thinking beyond view of the single patient • Mix of content/ mathematics/ application to health care system • Completion of CDC Epidemiology Course • Group writing project:

37. DNP Course Exemplars Advanced Clinical Management for the APN AND Advanced Clinical Practice Selective for ANP (clinical course) • Case based course addressing advanced diagnostic reasoning • Analysis of clients with complex health maintenance, health promotion and illness issues at the individual, family and aggregate levels • Application of principles of ethical decision making • Examination of personal clinical decision processes • Critique of peer clinical decision processes • Clinical in area of interest; not own practice

38. DNP Course Exemplars DNP Residency (two courses): • Clinical management of clients with complex health maintenance, health promotion and illness management needs focusing on a continuum of care within health care systems or organizations • Implementation of clinical project can be component • Set own objectives for clinical practice component of course • Clinical in area of interest or site of project • Can be their practice site

39. DNP Course Exemplars DNP Project (two courses): • Project which analyzes health care needs, develops an evidenced based intervention and evaluates outcomes for a specific population within an identified health care setting. • Development, writing, evaluation of project • IRB review commonly needed • Can be at practice site

40. DNP Project Exemplars DNP Project Examples: • Comparative Assessment of Extracellular Volume Excess in Hypertensive Hemodialysis Patients Using Blood Volume Monitoring • Identifying Patients at Risk for Obstructive Sleep Apnea in Primary Health Care • Use of Spirituality in an Older  Population with Chronic Illnesses • The Impact of Pre-Operative Mupirocin Prophylaxis on Surgical Site Infections in Same-Day Open Heart Patients • Effectiveness of Probiotics Preventing Antibiotic Associated Diarrhea and C Difficile in Long Term Care

41. Part 4: Lessons Learned from the Development, Implementation and Outcomes of a DNP Program Dr. Susan Chase PhD, FNP-BC, ARNP Professor and Associate Dean for Graduate Affairs UCF College of Nursing

42. Lessons Learned Problems and solutions from a new large cohort of doctoral students: • Student lounges • Communication with student • Student organizations • Student support • Faculty bias

43. Lessons Learned Staying on target: Admissions • Identifying quality candidates • Admission rubrics • Competitive GPA • GRE • Letters of Recommendation (smallest component) • Statement addressing goals ands clearly reflecting population specialty track preference • Resume (two-page limit) which reflects prior education, recent clinical accomplishments, any scholarly work, activities with professional organizations • Ongoing analysis of data to identify best predictors for success

44. Lessons Learned Staying on target: Formative Evaluation and ongoing course review • Ongoing course review • Full DNP faculty discussion of courses, content focus, texts, assignments and activities • Moving students to completion • DNP student evaluation each year • Review of progression with advisor yearly

45. Lessons Learned Formative Evaluation Exemplar • Original EBP course for all Post MSN to refresh learning/ knowledge and refine skills for identification of problem, literature search, writing and creation of practice recommendations • Could not do it!! • Solution: Evidence for Practice Course

46. Lessons Learned Solution: Evidence for Practice Course • Analyze contexts of nursing practice to identify gaps in practice quality. • Develop search strategies to obtain evidence related to practice problems • Critique studies as to applicability and rigor. • Synthesize knowledge from published evidence to recommend practice changes. • Consider perspectives of multiple disciplines in approaching health problems. • Align questions with national policy recommendations. • Demonstrate academic writing fluency.

47. Lessons Learned Solution: Evidence for Practice Course: Assignments • Practice analysis in context • Bibliographic strategy • Skill Development • Identification of clinical questions • Identification of publications which answer question • Critique of studies • Synthesis of studies • Formal paper summarizing EBP publicaiotns which answer a clinical questions (APA)

48. Lessons Learned Staying on target: Formative Evaluation and ongoing program implementation • Challenges of Doctoral Thesis Committees • Organizing Committees • Currently traditional MSN/ doctoral committee approach • Issue related to number of students relative to number of faculty • Issue related to high research focus of College of Nursing with many undergraduate Honors in the Major paper needing faculty support • Change from Doctoral Thesis to Project • Moving to cohort approach for DNP thesis

49. Lessons Learned Staying on target Summative Evaluation of program outcomes • Student meetings with dean • Dean involved with development of thesis/ projects • Evaluation by multiple faculty of quality of DNP Theses on completion • Evaluation of paper • Evaluation of presentation • Evaluation of end of program portfolio

50. Lessons Learned Staying on target: Summative Evaluation of student outcomes: • Tracking of presentations, publications • Changes in earnings after the DNP earned • Changes in patient colleague responses to them • Changes in practice depth/ scope on individual patient and practice basis • Recognition from colleagues because of the additional competencies gained, • Implementation of quality improvement, evidence based practice and financial analysis of practice