2010 Teaching and Learning Scholars Program March 2010 Project Snapshot

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1 M. Helena Myllykoski, School of Nursing, Department of Health and Community Studies Encouraging Advocacy Action in Nursing Students Mount Royal College 4825 Mount Royal Gate, Calgary AB T3E 6K6 Research Question: What is it about the clinical practice course experiences that generate student involvement in patient advocacy? Project Summary: Apathy toward disenfranchised groups and lack of application of social justice framework in clinical nursing practice is a direct threat to health status of individuals and communities. One way to enact social justice is as an advocate for clients. When students are given opportunity to reflect upon their developing practice and consider their developing professional role, acting as an advocate for marginalized or disenfranchised populations may become meaningful for the student. The intention is that they will build upon the incorporation of these ideals into their practice. Students will be working within a community setting with mental health clients and completing several learning activities concerning the care measures for these clients. Departmental and Institutional Context: The School of Nursing (SON) is part of the Department of Health and Community Studies and currently admits about students per year into a four year Bachelor of Nursing Program. The students in this study will be completing an eight week course in mental health/psychiatric nursing and are in their third year of the program. This clinically based course will be accompanied by a theory course and runs over an 8 week period. Eight students in this study cohort will be placed in a variety of community based clinical settings and will work with a mentor-nurse and the instructor in organizing and providing care for clients with mental health concerns. For three days per week, students will encounter several patients with varying diagnostic concerns and are expected to incorporate the theory gained in class into their developing practice. Theoretical content includes concepts of social justice, advocacy, social determinants of health and other more pragmatic theory concerning diagnosis and treatment from medical model perspectives. Data Required to Answer your Research Question: Students will be completing various projects and activities as part of the usual course delivery. These written assignments will be mined for evidence of patient and/or population advocacy intentions or actions taken by the students. Page 1

2 Course intents are outlined to students at the onset of the course an includes statements concerning looking at broader determinants of health and considering how these determinants influence the health status of clients. Advocacy, although brought forward in several nursing theory classes, is not specifically requested of the students in the written intents but should normally be considered by students as part of nursing practice. At the onset of the study, students will be asked to outline what they already know about community nursing and client advocacy as a baseline data source. The usual assignments will not be altered so as to avoid leading students in a manner that may bias the study. Students will be interviewed following the completion of the course, in a focus group setting, to glean information and data concerning their own understanding of advocacy as part of practice. Methods of Gathering Data: The following data sources will be collected from student work: 1. Blackboard online discussion concerning their initial understanding and experience with client advocacy as part of nursing practice. 2. Online discussion board with articles (attached at appendix) with directed discussion concerning the local issues concerning those with Mental Health concerns and service issues. 3. Online discussion board with film and article concerning the following discussion: What components of the film could you identify as advocacy for the mentally ill? What barriers and impediments do you identify to patient advocacy and what solutions do you consider to address the barriers? Students will be asked to consider how their current experiences in the clinical setting may be applicable. 4. Students will submit two reflective writings that will not be directed other than asking students to consider their clinical experiences, outline the relevance to their practice development and what they intend to do about that experience (ie. Action taken or intended). 5. Mental Status Examination (MSE) assignment: Students are required to complete a formal MSE which provides objective data as to the client s current mental status and symptom experiences. They will be required to outline some historical information, coping mechanism, access to health care by the client and potential nursing action strategies as part of this assignment. 6. Student self evaluations at mid-term and final point in which students evaluate how they have met intents of the course. This will include commentary about activities and actions that may include advocacy. 7. Post course focus group to discuss how advocacy has been or could be part of their practice. I would like the group to discuss what aspects of the course were useful, or not, in giving them opportunity to practice advocacy on behalf of the clients they encountered. Page 2

3 Anticipated Evidence: Having developed a theoretical understanding of the importance of client advocacy in ethical nursing practice, students will incorporate advocacy action as part of their developing nursing practice with confidence. While in community settings, students will broaden their understanding of the client population characteristics and their health needs. They will evaluate the social determinants of health and consider how they impact health status for the population. Given that social determinants can be defined as the social conditions and environment within which the population is situated, students will broaden their understanding of what influences health beyond the limiting notions of healthy behavioural choices and genetics. Students will consider that socio-economic status, social and health care support, housing, income, opportunities for leisure and personal development and other social determinants can influence mental health. Recognizing that mental health clients often encounter stigma and marginalization and experiences of disenfranchisement, students will identify opportunities to act as advocates on behalf of clients or population groups to address inopportune social circumstances. Advocacy may involve a broad array of actions or intents on behalf of the students and may be evidenced in various activities the students undertake as part of the course. Evidence of advocacy may take many forms including discussions with their mentor nurses, collaborative conferencing and problem solving with other healthcare professionals, acting to empower clients to act on their own behalf to meet their needs, writing letters to appropriate authorities concerning the populations needs, informing clients of their rights and providing them with opportunity to address concerns or discussions with healthcare leaders. Students may encounter obstacles to advocacy which in itself is a learning opportunity for students reinforcing awareness of the need to act. In gaining a better understanding of the students understanding of advocacy as a professional role and responsibility will open the door to discussing barriers to action. Students may encounter a number of impediments to client advocacy which may have either an intrinsic quality or arise from external forces or both. Discussion in written or verbal formats allow student to explore the concepts gaining further appreciation of their developing professional roles and scope of practice. Project Timeline: March 2010 Ethics Application completion and submission April 2010 Further literature review and investigation into qualitative data analysis methodology, development of data collection methods June 2010 attending conference Adler Institutute, Chicago The Institute on Social Exclusion will host its annual conference at The Drake Hotel-Chicago. The conference is entitled "The Social Determinants of Mental Health: From Awareness to Action." The purpose of the gathering will be to increase awareness and understanding of the impact of social conditions on mental health and well-being. Page 3

4 July-Aug 2010 refinement of data collection tools and methods, Kananskis conference Sept October 18 th Data collection during Block 1 Clinical Course NURS 3134 November- January data analysis Anticipated Claims about Student Learning: Community settings provide opportunities for nursing students to act as client advocates. Through both course work requiring application of theoretical concepts and interaction with client populations, students develop their skills as client advocates gaining a greater appreciate of the broader scope of nursing practice. In gaining practice as advocates and recognizing it s importance to the professional role of the registered nurse, students develop autonomy and enhance their leadership skills. These future nurse leaders, practicing toward a full scope of practice, will improve health care delivery for clients and broaden the scope of practice opportunity for all nurses. Anticipated audiences and Impact : Nursing educators and professional bodies have long held dialogue concerning the scope of practice of registered nurses. Often, nurses find that they are unable to practice in a fashion that celebrates the ideals brought forward in their studies. Constraints upon nursing practice may be imposed by numerous stake holders involved in health care or by nurses themselves. Encouraging our students to explore avenues that allow them to act as advocates invites further exploration of their roles as a nurse. In the changing landscape of health care delivery, whereby professionals are expanding upon their own scope of practice, creating overlap between professions, promoting full scope of practice is prudent and efficiently utilizes our human resources. The audiences most impacted by this process include professionals in practice, educators, interdisciplinary teams and most importantly, the recipients of health care the client populations. Educating nurses to be active leaders & advocates, conscious of larger impacts upon health outside of the historical models of healthcare delivery will positively influence the health status of our population. Literature Search Results (in categories or by keywords): Social Justice CNA documents International journal of Nursing Ecuation Scholarship, VOl 2, Issue 1 (2005) Nurse Educator Vol 35, No. 1 (2010) Journal of Child and Adolescent Psychiatric Nursing, Vol 23, No. 1 (2010) CAN Issues and Treans in Canadian Nursing, May 2000 Numerous other references Page 4

5 Social Determinants of Mental Health (SDOMH) Conference attendance (noted above) Social Determinants of health and nursing, CNA Heatlh Sociology review, Vol 16, Issue 2 Nursing Education Code of Ethics document CNA CARNA scope of practice documents Patient Advocacy Several articles forthcoming Additional Information, Comments, Questions: I starting using the wrong form so there is extra here and I was too attached to it to delete some of it. As I will be teaching spring courses 2010, and my data group will be available to me only in the first weeks of Fall 2010 semester (until mid-october), I will be moving my timeline forward accordingly giving me much stress and anticipation. I am starting to consider various research data analysis methods but will defer some of that work until after October. Page 5