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					  NURSING ON THE EDGE OF
POSSIBILITY: WHAT WILL IN TAKE
    BE CATALYST FOR CHANGE?

    Paula Gubrud Ed.D, RN FAAN
    Maine Partners in Education and
               Practice
             May 22, 2012
On the Edge of Possibility
               Transforming Nursing
                Practice and Education
                will require:
                  Acknowledging new
                   realities
                  New Curriculum
                  New Pedagogy for
                   New Learners
                  New Models for
                   Clinical Education
                  New Organizations
                  New Leadership
Nursing is Facing
          Increasing complexity
           of population needs
          Constant rapid change
           in our organizations
          Burgeoning use of
           knowledge and
           technology required to
           practice
          Paradoxical image at
           the edge of health care
           reform
Challenges
     Essentially static
      nursing education
      system
      Practice/Education Gap
      Immobilized by disputes
       about “levels of
       education”
      Uninformed by
       advances in science of
       learning
      Clinical education
       approaches unchanged
       since the 1940’s
  Oregon’s Innovations: In the
         beginning…
 Oregon Nurse Leadership
  Council/Collaborative
  A conflict in practice created opportunity for
   collaboration
Five Member Organization
    Oregon Council for Associate Degree Nursing
    Oregon Council of Deans
    Oregon Nurses Association
    Northwest Organization of Nurse Executives
    Oregon State Board of Nursing
  2001 ONLC Strategic Plan
 2 Goals related to nursing education

  ØDouble Enrollment

  ØTransform Nursing Education to align with
   today’s practice environment
    The Edge of Possibility
 New Curriculum to Prepare a “New Nurse”
   with competencies beyond those in our
    traditional nursing programs
   with deeper understanding of prevalent
    health care conditions and situations
   prepared to function in times of chronic
    nurse shortage
   prepared to lead and influence policy
   The Oregon Consortium for
       Nursing Education
A Partnership of Oregon nursing programs
  designed to:
  Prepare the “new” nurse with competencies
    needed for changing health care
    demographics
  Increase capacity in nursing programs
  Increasing number of baccalaureate graduates
    by creating shared 4 year curriculum
  Prepare leaders needed to influence new
    health care systems
   Redefining and Redesigning
           Curriculum
• Competency-based, directed toward
  knowledge & abilities needed to provide:
  • Patient/relationship centered care
  • For an aging & increasingly diverse
    population
  • In highly complex environments
  • That increasingly require interdisciplinary
    teamwork, leadership and use of quality
    improvement, informatics and technology
     Developing the OCNE
 Curriculum: Initial Agreements
• Competencies describe a “new” nurse

• Preparation of this new nurse will probably
  take 4 years

• Requires a new system of nursing education
  using all available resources from existing
  educational programs
Living on the Edge: Requires
     transformation of:
                Curriculum – outcomes,
                 selection, organization &
                 sequence of content &
                 learning experiences

                Pedagogy – assumptions
                 about the learning and
                 approaches that
                 recognize the continued
                 advances in the science of
                 learning and integrates
                 the characteristics of
                 diverse learners
     The OCNE Curriculum
 Baccalaureate curriculum with opportunity for
  community college students to complete AAS
  and sit for NCLEX on the way to BSN
 Built on redefined fundamentals
 Competency-based
 Integrated
 Spiral
Redefined Fundamentals
   Redefined Fundamentals
u Evidence-Based Practice
u Relationship Centered Care
u Clinical Judgment
u Leadership

In the context of Health Promotion
      Competency-based:
10 competencies which reflect - -
Ethical practice
Intentional (self-directed), reflective
 learner
Engage in teamwork and provide
 leadership
With strong communication skills and
 capable of systems thinking
Skillful clinical judgment and evidence-
 based practice
              Integrated

 Courses organized around foci of care:
   Health Promotion
   Chronic Illness Management
   Acute Care
   End-of-Life Care
 And “cross-cutting competencies”
   Leadership & Outcomes Management
   Population Based Care
Spiral
     providing for
      multiple encounters
      with most important
      concepts,
      dimensions of
      competencies, &
      health & illness
      context in varying
      populations &
      settings
       The New Pedagogy
 Draws on tremendous advances in the science
  of learning from a variety of disciplines
  (cognitive science, psychology, higher
  education)

 Emphasizes deep understanding of the
  discipline’s most central concepts
The New Pedagogy
         Guides design of
          learning activities
          which promote:
           Active
            engagement of
            the learner
           Clear
            performance
            expectations,
            practice and
            frequent, specific
            and constructive
            feedback
     The New Pedagogy
Guides design of learning
 activities which promote:
 Strong, learning-focused
  social interactions
 Development of habits in
  metacognition/reflection,
  self assessment, and self-
  directed learning
Active engagement in authentic
practice situations: Case-based
.
     CORE/Mega Cases that integrate across
      competencies, relate to highly prevalent
      health problems, across age span and diverse
      populations
     Dilemma cases underscoring ethical issues
     Unfolding cases, demonstrated clinical
      situations as they unfold
     Student narratives of their own experience
Reforming Clinical Education:
From Mother Duck to Mother
        Lode (Tanner 2010)
OCNE Clinical Education Model

 Purposeful Design of Clinical Education
 Considering development of
   Practical knowledge
   Skilled Know-how
   Habits of Thought
   Understanding of self as caring
    clinician
              CLINICAL LEARNING MODEL


                        Focused Direct
                          Client Care



Integrative                                      Intervention Skill
Experience                                      Based Experiences
                         CLINICAL
                         LEARNING




                                         Case Based
        Concept Based
                                         Simulation
CLINICAL LEARNING MODEL


                 Focused Direct
                  Client Care




                                           Intervention
   Integrative                                 Skill
   Experience                                 Based
                                           Experiences
                 CLINICAL
                 LEARNING




                                  Case Based
      Concept Based               Simulation
CLINICAL LEARNING MODEL


                             Focused Direct
                              Client Care




   Integrative                                      Intervention Skill
   Experience                                       Based Experiences


                             CLINICAL
                             LEARNING




             Concept Based
                                              Case Based
                                              Simulation
CLINICAL LEARNING MODEL


                     Focused
                       Direct
                    Client Care



 Integrative                       Intervention Skill
 Experience                        Based Experiences
                    CLINICAL
                    LEARNING




          Concept                 Case Based
           Based                  Simulation
CLINICAL LEARNING MODEL




                        Focused Direct
                         Client Care



   Integrative                                 Intervention Skill
   Experience                                  Based Experiences


                             CLINICAL
                             LEARNING




                                        Case Based
             Concept Based
                                        Simulation
CLINICAL LEARNING MODEL



                            Focused Direct
                             Client Care




    Integrative                                     Intervention Skill
                                                    Based Experiences
    Experience
                            CLINICAL
                            LEARNING




                                             Case Based
            Concept Based
                                             Simulation
Early Clinical Learning Experiences




  Concept Based
                        Case Based




                           Direct-
   Intervention-Skill     Focused
         Based              Care
Mid-Program Learning Experiences




                               Case Based



   Focused Direct
    Patient Care

                        Concept Based



                    Intervention
                           -
                     Skill Based
End-of-program clinical
     experiences

         Integrative Experience




     Intervention        Concept-
            -       II    Based
      Skill Based



                Case-Based
   OCNE Front Story: Planned
          Processes
 Coordinating Council
 Faculty committees
 Stakeholder involvement
 Agreement for a new kind of leadership
 Consortium-wide consensus building
  approach
 Faculty development & involvement
     Back Story:
The Lived Experience
            Developing trusting
             relationships
            Keeping the vision alive
            Setting the common
             good above individual
             interests
            Celebration and humor
             (Buttons)
            Inclusiveness
            Facilitation to smooth
             rough edges & move
             forward
          The OCNE Vision
 Front story – the statement of vision, tag line
  “Working together for healthy communities”



 Back story – commitment to collaborative
  process and preparing a new kind of nurse for
  future health care
       Adaptive Leadership to
            Transform
 Embrace ambiguity
  and tolerate false
  starts – to enjoy the
  “unfolding” process
    A “good enough
     vision”
    Paradox and Tension
    Multiple Actions
    Risk Taking
    Boundary Spanning
  Catalyst for Transformative
  Change: Requires the Whole
             Story
Guiding principles for working
 together
 Develop and Document
   (sometimes a facilitator will be
   needed)
 Front story – formal document
 Back story – living to the
   agreement
  Maine Nurse Leaders will be
          pouring…
Commitment to excellence
 Inclusiveness
 Beneficence, collegiality
 Courage/perseverance
Healthy conflict,
 and most importantly- support, embrace
     and celebrate your commitment
     to the health of Maine’s Citizens
If you want to go quickly, go alone.
 If you want to go far, go together.




      Ancient Proverb
FOR MORE INFORMATION

    Visit us at
   www.ocne.org
                     References
Gubrud, P., & Schoessler, M. (2010). OCNE clinical education model.
   In N. Ard & TM Valiga (Eds) Clinical nursing education: Current
   reflections (pp. 39-58). New York: National League for Nursing
Gubrud-Howe, P., & Schoessler, M. (2008). From random access
   opportunity to a clinical education curriculum. Journal of Nursing
   Education, 47(1), 3-4.
Gubrud-Howe P. Shaver KS. Tanner CA. Bennett-Stillmaker J.
   Davidson SB. Flaherty-Robb M. Goudreau K. Hardham L. Hayden
   C. Hendy S. Omel S. Potempa K. Shores L. Theis S. Wheeler P.
   (2003) A challenge to meet the future: nursing education in Oregon,
   2010. Journal of Nursing Education. 42(4):163-7
Heifetz, R., Grashow, A., & Linsky, M. (2009). The Practice of
   Adaptive Leadership. Boston MA: Harvard Business Press
Lindberg, C., Nash, S. & Lindberg, C. (2008). On the Edge: Nursing in
   the Age of Complexity. Bordentown, New Jersey: Plexus Press
      References continued
Tanner, C. A. (2010). From mother duck to
  mother lode: Clinical education for deep
  learning. Journal of Nursing Education, 49,(1), 3
  -4.
Tanner, C.A., Gubrud-Howe, P., & Shores, L.
  (2008). The Oregon Consortium for Nursing
  Education: A Response to the Nursing
  Shortage. Policy, Politics and Nursing Practice,
  9(3):203-09.
Zimmerman, B., Lindberg, C., & Plsek. (2008).
  Edgeware: Lessons from complexity science for
  health care leaders.
 

				
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