Re-imagining of an undergraduate, second-degree entry, accelerated nursing program's curriculum utilizing a postmodern, learner-centred lens and a concept-based framework.

INTRODUCTION: It is necessary to re-imagine nursing curriculums utilizing a postmodern approach, as outdated teacher-centred methods of nursing education with emphasis on memorization versus critical thinking no longer meet the needs of the contemporary learner and the current challenges of the healthcare environment. There is an explicit need to redesign nursing curriculums that are future-oriented, adaptive and flexible and serve the learners' best interests. BACKGROUND: Distilled from a decade of teaching experience in an undergraduate, second-degree entry, accelerated nursing program, this paper describes the construction of a learner-centred, postmodern, concept-based nursing curriculum that aims to foster learners' inquiry skills, critical thinking, problem-solving, and experiential learning-all which develop learners' autonomy, self-direction, and lifelong learning. The objective is to foster learners' transformational and emancipatory learning and metacognition. DISCUSSION: An extensive review of the current trends, contemporary nursing knowledge for the past decade (2013-2023), and seminal literature on theories and frameworks paralleled with the review of current and future trends in Canadian and global health care, including the socio-economic, politico and environmental contexts, led to the formulation of a concept-based curriculum. Grounded in the constructivist paradigm, the curriculum applies interperetivist, critical, feminist, and indigenous lenses. The Strength-Based Nursing framework was selected as the core guiding framework. The curriculum's four curricular themes and foundational pillars were adopted directly from the framework to provide a starting point for concept development. These initial themes were then juxtaposed with relevant nursing, and social theories, policies, and frameworks, ensuring a robust coverage of modern nursing knowledge and allowing for the core concepts of the curriculum to emerge. A total of 21 concepts and 192 sub-concepts were developed. CONCLUSION: Implications for future practice require nursing educators to receive support and professional development opportunities in developing skills and confidence in entering a classroom as co-learners and facilitators.

Preceptors' experiences of one to one preceptorship model for students undertaking an accelerated undergraduate nursing program: An interpretive descriptive qualitative study.

AIM: The aim of this research is to describe and interpret the experiences of preceptors' in supporting nursing students in a one-to-one model across all semesters of the nursing program. BACKGROUND: The one-to-one preceptorship model is widely used in Canada during the consolidation phase of a Bachelor of Science in Nursing program. The launch of an innovative two-year second-degree entry accelerated nursing program in partnership with several leading academically based health care delivery institutions in Ontario created a one-to-one preceptorship model that is offered within each semester of a two year nursing program. The literature on preceptorship models within baccalaureate programs suggest that the one-to-one preceptorship model can pose major challenges to nursing preceptors. Balancing the competing demands of providing excellent nursing care for complex patients in today's health care environment with the responsibilities of teaching nursing students were highlighted as major factors of the preceptor experience. Balancing the demands of care provision with the responsibilities of teaching nursing students is shown to be a shared experience among preceptors working with consolidating nursing students. However, a gap exists in understanding how these preceptor experiences unfold with nursing students who attend clinical practicum for nine weeks each semester of the program. DESIGN: This study employs an interpretive descriptive design. METHODS: Using a purposeful sampling technique, nine Registered Nurses from one affiliate organization, were invited to 30 - 60 min semi-structured, face to face interviews. Thematic and pattern analysis supported the data analysis. RESULTS: Four major themes emerged: acknowledging expectations to teach, recognizing preceptor needs, balancing the act of nursing and teaching and discovering self through the preceptorship experience. To make the new meaning more accessible, a conceptual interpretation of the themes were transformed into a metaphor that depicts the relationship across the meaning units. The image of a bamboo tree represents both the descriptive and interpretive insights. CONCLUSION: This study illuminates the role competency of preceptors involved in a one-to-one preceptored model in a second-degree accelerated nursing program. A continued use of a one to one preceptor model within each semester of a two-year program serves as a platform to foster cognitive companionship, clinical teaching and experiential learning opportunities.

A Clinical Nurse Specialist-Led Interprofessional Quality Improvement Project to Reduce Hospital-Acquired Pressure Ulcers.

PURPOSE: The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. BACKGROUND: Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. RATIONALE: Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. DESCRIPTION: This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. OUTCOME: An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. CONCLUSION: The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. IMPLICATIONS: This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.

Developing nursing expertise in caring for older advanced stage heart failure patients and their families--palliative and end-of-life care.

Patients living with chronic heart failure (CHF) often have poor quality of life and similar symptoms as patients with cancer. Despite this, these patients receive less specialist palliative care. Some of the major barriers in providing high-quality care for end stage CHF patients are the conflicting conceptualization of palliative care among health care professionals as a system of care delivery at the terminal phase of the illness versus philosophy of care introduced early in conjunction with life-prolonging treatments, the unpredictable nature of the illness trajectory, lack of knowledge among acute care nurses about palliative care and lack of communication with patients and their families. The aim of this article is to identify evidence-based strategies and frameworks that would aid nurses and other health care professionals in the integration of palliative care into the care path of CHF patients.