Transforming nursing curricula for a global community.

With nurses and midwives providing the majority of health care globally, nursing education in all countries must prepare students for broader responsibilities to move the agenda forward for equitable care and universal health coverage. Columbia University School of Nursing developed and implemented a vibrant approach to curriculum transformation that included a new didactic course followed by a program of global clinical experiences to expand students' learning environments in global health. Program planning included defining learning objectives, mobilizing support within the school, establishing new sites, recruiting and preparing students, overseeing of students with host institutions, and evaluating the program. A total of twenty-four students were placed over five sites for a six-week credit-bearing global clinical experience. Students had varied clinical experiences with new understandings of the reality of health disparities. Host sites expressed a commitment to have students return in the next year, and all students stated that they would chose a global experience again. This innovation provides a transformative addition to nursing education with a deepened understanding of health disparities and nursing roles in different health systems. It strengthens the school's network of nursing and midwifery educators and opens doors for new exchanges.

Web-based hazard and near-miss reporting as part of a patient safety curriculum.

As part of a patient safety curriculum, we developed a Web-based hazard and near-miss reporting system for postbaccalaureate nursing students to use during their clinical experiences in the first year of their combined BS-MS advanced practice nurse program. The 25-week clinical rotations included 2 days per week for 5 weeks each in community, medical-surgical, obstetrics, pediatrics, and psychiatric settings. During a 3-year period, 453 students made 21,276 reports. Of the 10,206 positive (yes) responses to a hazard or near miss, 6,005 hazards (59%) and 4,200 near misses (41%) were reported. The most common reports were related to infection, medication, environmental, fall, and equipment issues. Of the near misses, 1,996 (48%) had planned interceptions and 2,240 (52%) had unplanned interceptions. Types of hazards and near misses varied by rotation. Incorporating hazard and near-miss reporting into the patient safety curriculum was an innovative strategy to promote mindfulness among nursing students.

Development of a self-report instrument to measure patient safety attitudes, skills, and knowledge.

PURPOSE: To describe the development and psychometric testing of the Patient Safety Attitudes, Skills and Knowledge Scale (PS-ASK). METHODS: Content validity of a 35-item instrument was established by a panel of experts. The instrument was pilot tested on 285 nursing students. Principal components analysis (PCA) with varimax rotation was conducted, and Cronbach's alphas were examined. Paired samples t-tests were used to show responsiveness of the scales pre- and post-patient safety curriculum. RESULTS: The final instrument consists of 26 items and three separate scales: attitudes, skills, and knowledge. The attitudes and skills scales each had a three-factor solution. The knowledge items had a one-factor solution. Both skills and knowledge were significantly increased at Time 2 (p<0.001). CONCLUSIONS: The skills and knowledge subscales had satisfactory internal consistency reliability, evidence for construct validity, and responsiveness for use as independent scales in future studies. The attitudes subscale needs further refinement before implementation. Comparison with other measures of patient safety skills (e.g., observation) and knowledge are warranted. CLINICAL RELEVANCE: A tool to measure clinicians' attitudes, skills, and knowledge about patient safety might be useful to evaluate nurses and other clinicians during educational preparation and in practice.

Near-miss and hazard reporting: promoting mindfulness in patient safety education.

Patient safety efforts advocate for transforming healthcare from a culture of blame to a non-punitive "culture of safety." One of the most challenging hurdles is to encourage healthcare practitioners to be mindful about their activities. To promote mindfulness during clinical education for entry-level nurses, we developed a web-based dangerous situation and near miss reporting system for a cohort of baccalaureate nursing students (N=156). For this curricular innovation project, we provided wireless handheld devices to students who were required to submit one report for each of their clinical days in the medical-surgical, pediatric, psychiatric, obstetrics and community settings. During a ten-week period, students submitted 1487 reports. Of these, 63% were dangerous situations and 37% were near misses. The most frequently occurring dangerous situations were poor infection control practices. The most commonly reported near misses were medication errors. Free text comments from students identified inadequate patient identification and poor documentation as commonly occurring dangerous situations observed.

Nursing home staff's perceived ability to influence quality of life.

Nurses, certified nursing assistants, activity personnel, social workers, and physicians in 5 cities rated their ability to affect each of 17 quality of life (QoL) items for 2 hypothetical cases. Those closest to the residents feel the most empowered to make a difference. Overall, certified nursing assistants were consistently the most optimistic about their ability to influence QoL. Perceptions of ability to influence QoL were correlated with attitudes about nursing homes. These perceptions may be helpful in retaining such staff.

Effect of an informatics for evidence-based practice curriculum on nursing informatics competencies.

Effective and appropriate use of information and communication technologies is an essential competency for all health care professionals. The purpose of this paper is to describe the effect of an evolving informatics for evidence-based practice (IEBP) curriculum on nursing informatics competencies in three student cohorts in the combined BS/MS program for non-nurses at the Columbia University School of Nursing. A repeated-measures, non-equivalent comparison group design was used to determine differences in self-rated informatics competencies pre- and post-IEBP and between cohorts at the end of the BS year of the combined BS/MS program. The types of Computer Skill competencies on which the students rated themselves as competent (> or =3) on admission were generic in nature and reflective of basic computer literacy. Informatics competencies increased significantly from admission to BS graduation in all areas for the class of 2002 and in all, but three areas, for the class of 2003. None of the three cohorts achieved competence in Computer Skills: Education despite curricular revisions. There were no significant differences between classes at the end of the BS year. Innovative educational approaches, such as the one described in this paper demonstrate promise as a method to achieve informatics competence. It is essential to integrate routine measurement of informatics competency into the curriculum so that approaches can be refined as needed to ensure informatics competent graduates.

Cognitive impairment and quality-of-life: views of providers of long-term care services.

Quality-of-life (QoL) is now recognized as a principal outcome marker for long-term care. However, QoL is difficult to define and measure, especially in residents with dementia. Providers of long-term care services (n = 182) were asked to rate the importance of 19 psychosocial quality-of-life elements for hypothetical residents with physical impairment and for residents with cognitive impairment. Respondents also were asked to rate their ability to influence these elements for each type of resident. Respondents rated the importance of 18 of the 19 elements and their ability to influence 17 of 19 elements lower for residents with cognitive impairment. Of the five types of respondents, certified nursing assistants (CNAs) rated their ability to influence these QoL elements the highest for both types of residents; physicians' ratings were the lowest. Pain management was given high ratings for both importance and ability to influence for both resident types; the lowest ratings were given for elements that pertained to residents' understanding. A strong correlation between ratings for importance and ability to influence was observed. Additional research is needed on the psychosocial aspects of long-term care residents' QoL, especially those with cognitive impairment.

Rating the importance of nursing home residents' quality of life.

OBJECTIVES: To assess how various stakeholders involved with nursing home care rate the importance of various quality-of-life (QoL) items for hypothetical residents with varying types of impairment. DESIGN: A community-based exploratory description of a convenience sample. SETTING: Eleven nursing homes in Florida, New Jersey, and Minnesota. PARTICIPANTS: Samples of registered and licensed nurses (RNs and LPNs), certified nursing assistants (CNAs), activities personnel, social workers, physicians, residents, and family members. MEASUREMENTS: Using a magnitude estimation approach, 17 QoL items were rated in order of importance on each of three hypothetical types of nursing home residents. RESULTS: Overall, there was little variation in the ratings for individual items. Ratings for persons with cognitive impairment were consistently lower. RNs'/LPNs' and CNAs' ratings were generally higher than the others, and physicians' ratings were generally lower. Residents' and families' ratings were generally lower than nurses' ratings. CONCLUSION: All stakeholders considered QoL to be important and felt that it deserves more attention in practice and regulation. A summary QoL score need not be weighted. Respondents (who were not cognitively impaired) considered QoL less important for residents with cognitive impairment. Value differences between those involved in nursing home care deserve more exploration.

Promoting patient safety through informatics-based nursing education.

The Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing safe and effective health care. In addition to technical aspects such as regional or national health information infrastructures, to achieve this goal, healthcare professionals must receive the requisite training during basic and advanced educational programs. In this article, we describe a two-pronged strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing: (1) use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care, and (2) enhancement of informatics competencies of students and faculty. These approaches may be useful to others wishing to promote patient safety through using informatics methods and technologies in healthcare curricula.