Executive Summary
As interprofessional communication becomes a priority in enhancing patient-centered care and patient safety in healthcare settings,
... [Show More] nursing programs are challenged to develop and implement curriculums that can prepare students to meet this need in an already complex healthcare system. Hence, this curriculum proposal, which is organized using the ADDIE model, aims at bridging the identified curriculum gap through the enhancement of students’ interprofessional communication skills.
In the proposal analysis phase of this paper, an overview of the academic setting—the curriculum gap was identified—is presented, and there is a discussion on the knowledge and skills of senior nursing students. By surveying the stakeholders through the gap analysis, it was identified that these students lack interprofessional communication skills. Through the force field analysis, the forces for and those against were identified, with the “forces for” scoring higher than those against; hence, a favorable implementation of the curriculum proposal.
In the proposal design phase of this project, the results from the gap assessment conducted in the Analysis phase were used in the documentation of the instructional design and application of design strategies. Rather than creating a new course syllabus, the existing syllabus for the Nurse 489 course was modified to include a new module: enhancing interprofessional communication in nursing students through the use of Clinical Virtual Simulation.
Through independent and collaborative activities, the course elements for this new module were created.
As the author moves through the proposal development phase of the project, there was the integration of all contents in the development phase to create a student-facing product, comprising of a five-question formative assessment, 10-item summative objective assessment
written at the cognitive application level of the Blooms Taxonomy, and an authentic summative performance assessment. In this phase, the proposal was presented for review, and it was revised based on the feedback from the stakeholders and the preceptor in preparation for implementation.
In the proposal implementation planning phase of this projection, there was the establishment of the procedure for training faculty and learners. This training included learning outcomes, methods on how the learning will be delivered, and how students will be evaluated. An implementation timeline is also presented. Procedures for the pilot test and full implementation of this proposal is well discussed in this phase. Also included in this phase are anticipated barriers, technical issues, or resistance that might be met, and actions to resolve these issues are presented.
The last phase of this project is the evaluation planning phase. Included in this phase is a 10-item End-of-course survey to evaluate if the implemented curriculum met the intended objectives. Ongoing evaluation procedures and ways to revise the implemented curriculum based on the feedbacks of the students and faculty are also presented.
Introduction
The report from the Institute of Medicine (IOM) (2001) indicated that
communication errors or poor communication among healthcare professionals are the leading cause of adverse or sentinel events in healthcare. To minimize these adverse effects, improve safety, and enhance quality patient outcomes, the World Health
Organization (2010) has promoted the implementation of interprofessional learning in undergraduate studies. According to a 2013 report released by the World Health
Organization (WHO), the advancement of interprofessional learning and simulation in students, especially those in healthcare, would improve their communication and
collaboration skills; thus, preparing them to engage in interdisciplinary collaboration with their colleagues during their clinical rotations and when they become professionals.
Hence, one of the criteria for selecting the academic setting to conduct this field experience was an academic institution that has implemented interprofessional communication in its curriculum.
The university where this Field Experience was conducted is located in the
part of Louisiana. This nursing program incorporates online course work into the curriculum plan of the program. As one of the only local universities that provide online graduate education, it is known in its community for the high quality and reputable students it has produced. The environment at this university is one that is conducive for learning and fosters independence, guidance, and respect. Students are encouraged to speak out their concerns and seek mentorship from their advisors. This environment preaches diversity and welcomes everyone, irrespective of religious beliefs, sexuality, or race. The Academic Nurse Educator that served as the preceptor for this Field Experience course functions in many roles that support the
mission and vision of the organization. She is involved in teaching, scholarship, and service. Her student population is diverse. In each class, she has about 20-35 students, with ages ranging from 21-35 years, with the majority being females. This program is a 2.5 years program after successful completion of the required prerequisites. Most of the classes in this program have a clinical component; hence, the preceptor also functions as a clinical faculty. With the many healthcare facilities located in this community, students have many clinical sites to obtain their clinical hours.
During the field experience, the course where the curriculum gap was identified is known as Advanced Concept in Nursing Practice (Nurse 489). This course provides students the opportunities to refine their critical thinking, decision- making, and communication skills in the nursing care of diverse populations across the life span in an ever-changing and complex healthcare environment. It prepares each student to function effectively and efficiently in entry- level caregiver, manager, and team member nursing roles. Since students enrolled in this course spend the majority of the semester hours in the clinical setting, it was identified that these students and students enrolled in this school of nursing lack interprofessional communication skills, despite the incorporation of interprofessional education in the fundamental nursing courses. This lack of interprofessional communication skills is evident by the multiple suspensions of students from clinical rotations due to medication errors as a result of failing to communicate with their preceptors adequately and that more than 70% of graduating seniors did not score more than 60% on the interprofessional communication and collaboration section in the exit exam.
Furthermore, in order to bridge this curriculum gap identified during the field experience, a detailed curriculum change proposal will be drafted. This proposal aims to provide a systematic
approach on how to incorporate an interprofessional communication module in week five of the Nurse 489 syllabus. After conducting a literature review on enhancing the interprofessional communication skills in nursing students, a detailed curriculum need-gap analysis will be drafted, indicating action steps to meet this need-gap. This curriculum need-gap analysis will be presented to the stakeholders, and brainstorming will be done—with the goal of coming up with various ideas and suggestions. Suggestions and ideas from this meeting with the stakeholders will be used to construct an affinity diagram. Prior to the implementation of the curriculum proposal, the student and faculty in this organization will be analyzed for their readiness. The result from this force field analysis will be significant in determining if the forces for the implementation of the proposal is stronger than the forces against the proposal.
Lastly, the theoretical framework that underpins this curriculum proposal is the Kolb Experiential Learning Theory. According to David Kolb (1984), experiential learning is “the process whereby knowledge is created through the transformation of experience. Knowledge results from the combinations of grasping and transforming the experience.” Hence, based on this theory, this curriculum proposal postulates that as nursing students transition from one semester to the other, they are expected to apply the knowledge acquired in order to enhance their nursing skills.
Literature Review Summary Table.
See table 1, Literature Review Summary Table.
Curriculum Gap and Potential Causes.
In this field experience, the author worked closely with a faculty who teaches
senior-level nursing courses at a state university in Louisiana. Students
enrolled in this class spend the majority of their semester hours in specialized clinical settings, such as the Operating Room, Intensive Care Unit, and Cardiac Cath-lab. During the field experience, it was identified that as senior nursing students engaged with
interdisciplinary team members in the clinical settings, they lack the interprofessional communication skills that are highly required to minimize adverse effects, improve patient safety, and enhance quality patient outcomes. This lack of interprofessional
communication skills exhibited by these students is evident by the multiple suspensions of students from clinical rotations due to medication errors as a result of failing to communicate with their preceptors adequately; more than 70% of graduating seniors did make more than 60% on the interprofessional communication and collaboration section in the exit exam; and employers not satisfied with the interprofessional communication skills of recent nursing graduates who were hired into the workforce. This curriculum need-gap exists because this nursing program has yet to revised its senior-level curriculum to include this national
patient safety goal that has been identified internationally by significant healthcare
bodies, such as the Joint Commission, the Australian Commission on Safety and Quality in Healthcare, and the World Health Organization. In 2015, the joint Commission
reported that human factors, leadership, and communication were the three major causes of sentinel events in the United States in 2014 (Joint Commission, 2015).
Ideally, when developing a nursing curriculum plan, students’ prior knowledge, experiences, and learning styles on specific topics are taken into consideration. The curriculum committee should develop course outlines that students can build upon the
knowledge and experience they gained from the previous courses as they advance through the program—a learning theory known as the constructivist learning theory. The
constructivist learning theory is an approach to learning that holds that learners acquire new knowledge on the foundation of previous knowledge and experience and that this
prior knowledge has an influence on the new information and experience the learner will acquire in the future (Bastable, 2017). Hence, the existence of this curriculum gap in this nursing program is due to the lack of revision of the senior-level curriculum for more than five years because this curriculum was developed based on the constructivist learning theory. In this nursing program, the concept of interprofessional communication is introduced in the fundamental courses, that is, in the first and second semesters of the three-year program. Hence, students are expected to apply the knowledge gained from these semesters as they advance in the program. Evidently, since this knowledge is not being reinforced as students progress in the nursing program, senior nursing students have failed to apply the concepts they learned in their during their clinical rotations, leading to the lack of interprofessional communication skills. It could also be argued that another cause of this curriculum need-gap is that the changes that have been made in the field of nursing for the last ten-years—such as patient and family-centered care and collaborative healthcare practice-- are not reflected in this nursing program’s curriculum.
Research findings and Support of Proposal
Since this curriculum proposal involves enhancing the interprofessional
communication in nursing students through the use of clinical virtual simulation, the
review of the literature was done in three phases to include all the pertinent criteria. Firstly, the many literatures on Virtual simulation in nursing were reviewed. Next,
literature pertaining to interprofessional communication in health care were also reviewed. Lastly, four research studies on improving interprofessional communication skills in nursing students through the use of virtual simulation were included to be reviewed. [Show Less]