Bringing back the basics of nursing: defining patient care essentials.

Nursing leadership involves creating and sustaining a professional environment where nurses can perform at the highest levels of their preparation and expertise. As the work of nursing becomes increasingly more complex and significantly more technical in nature, nurses are beginning to find that the basic nursing interventions that were once the hallmark of good nursing care are being left behind. The purpose of this article is to describe an initiative to develop a clearly defined set of consensus-driven expectations about those essential, foundational elements of nursing care that nurses strive for and which we wanted to be universal within our organization, no matter where the patient receives care. The leadership challenge was to convey expectations that encompass both the tasks of nursing care and the compassionate environment in which the care is delivered. Adding to the complexity of this goal was the recognition that we would be much more successful in meeting these standards consistently if the expectations were grounded in the experience of direct care nurses, explicitly described and intentionally specified. This article describes the various phases of this initiative and includes the resulting "Patient Care Essentials" document.

The 'Collaborative Care' curriculum: an educational model addressing key ACGME core competencies in primary care residency training.

AIM: The 'Collaborative Care' curriculum is a 12-month senior resident class project in which one evidence-based clinical guideline is designed, implemented and evaluated in our residency practice. This curriculum specifically addresses three of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies: Practice-Based Learning and Improvement, Interpersonal and Communication Skills and System-Based Practices. Additionally, the project enhances the quality of patient care within the model family practice centre in a family practice residency. METHODS: During the project, the third-year residency class selects the disease, develops the clinical guideline, leads its implementation and guides the evaluation process. Select faculty members serve as mentors and coach the resident class through each phase of the project. Specific educational objectives are developed for each content area: evidence-based medicine, clinical guideline development, continuous quality improvement and team leadership. A series of seminars are presented during the project year to provide 'just-in-time' learning for the key content and skills required for each step in the project. By working together to develop the practice guideline, then working with nurses and allied health staff to implement the guideline and review its effectiveness, the resident team gains competence in the areas of practice-based learning and improvement, interpersonal and communication skills and system-based practices. RESULTS: The self-reported level of resident confidence in skill acquisition for each content area was measured for each resident at the time of graduation from the residency programme. Results from the first 2 years of this curriculum are reported (resident n = 12), and demonstrate a high level of physician confidence in the skills addressed and their utility for future practice. CONCLUSIONS: The senior resident seminar and team project model reported here creates learning experiences that appear to address at least three of the ACGME general competency expectations: practice-based learning and improvement, interpersonal communication skills, and systems-based practice. From the initial resident feedback, this educational model seems to establish a high level of physician confidence in the skills addressed and their utility for future practice.