The Case Study: Public Health Nursing Practice

Transcription

1 Building and Using Evidence in Population Based Nursing Care: Challenges and Opportunities 2013 ACHNE/APHN Joint Meeting Martha Keehner Engelke, RN, PhD, CNE Associate Dean for Research and Creative Activity Richard R. Eakin Distinguished Professor East Carolina University College of Nursing NLN Center of Excellence Top Ten On line Distance Education Master s Program Largest graduation of new BSN Students (admit 13o students twice a year) with consistent NCLEX pass rates >95% PhD program for 10 years (3 5) students/year New DNP program in Fall, 2013, over 100 applicants for 2o slots. Mission To serve as a national model for regional transformation through nursing education, practice, and research. What do we mean by evidence? 1

2 What is good Evidence Phases of NIH Clinical Trials Phase I : Researchers test an experimental drug or treatment in a small group of people (20 80) for the first time. The purpose is to evaluate its safety and identify side effects. Phase II trials: The experimental drug or treatment is administered to a larger group of people ( ) to determine its effectiveness and to further evaluate its safety. Phase III trials: The experimental drug or treatment is administered to large groups of people (1,000 3,000) to confirm its effectiveness, monitor side effects, compare it with standard or equivalent treatments. Phase IV trials: After a drug is approved by the FDA and made available to the public, researchers track its safety, seeking more information about a drug or treatment s risks, benefits, and optimal use. 2

3 The reality for PHN Interventions.. Do School Based Asthma Education Programs Improve Self Management and Health Outcomes? Coffman,J; Cabana, M; Yelin, E (2009) Pediatrics 124: Twenty five articles (out of 358 screened) met the inclusion criteria. Synthesizing findings across studies was difficult because the characteristics of interventions and target populations varied widely, as did the outcomes assessed. In addition, some studies had major methodological weaknesses. Most studies that compared asthma education to usual care found that school based asthma education improved knowledge (7 of 10), self efficacy (6 of 8), and selfmanagement (7 of 8). Fewer studies reported favorable effects on quality of life (4 of 8), days of symptoms (5 of 11), nights with symptoms (2 of 4), and school absences (5 of 17). Due to the sequester and rising numbers of applications, NIH has had to significantly cut funding, and its success rates are at an historic low of 16 percent. There is so much wonderful science being proposed now, he continued: The number and quality of research proposals going unfunded have never been higher in the 67-year history of NIH grants. % of NINR Proposals Funded 2012 Percent of Proposal Proposal Funded Funded Funding Proposals Mechanism Submitted Amount Awarded R % $23,967,078 R % $689,967 R % $434,259 R % $5,336,174 Center for Scientific Review Director Dr. Richard Nakamura 3

4 HRSA Funding Type of Award Advanced Nurse Education (2012) Advanced Nurse Education (2013) Advance Education Nurse Traineeships Student Eligibility Primary Care Providers (NPs, midwifery) Primary Care Providers (NPs, midwifery) Primary Care Mandatory Concepts Technology Interprofessional Practice Multiple Chronic Illness, Interprofessional Practice 2 yr. funding, more tracking of clinical and practice sites after graduations NEPR (2013) Practice or CONs can apply Interprofessional practice or education for interprofessional practice Creative Strategies for Funding Grants Training/Education Grants Foundations Grants Robert Wood Johnson Benefactors/Endowments Other Creative Strategies The Future of Nursing: Leading Change Advancing Health/ For the Public s Health: Investing in a Healthier Future Nurses should : Practice to the full extent of their education and training. Achieve higher levels of education Be full partners, with physicians and other health care professionals, in redesigning health care in the US. Have better data collection and an improved information infrastructure To improve health outcomes in the United States, we will need to transform the way the nation invests in health to pay more attention to population based prevention efforts; remedy the dysfunctional manner in which public health funding is allocated, structured, and used; and ensure stable funding for public health departments. 4

5 RWJF Forum on the Future of Public Health Nursing (2012) Build and communicate a shared vision for the role and value of public health nursing. Develop and test new models for public health nursing practice. Develop and disseminate new educational models. Forge new strategic partnerships. Expand leadership development opportunities. Expand the evidence base for public health nursing practice. Recommendations or Next Steps Explore strategies to demonstrate the effectiveness/value of promising PHN practice interventions, including pilot/demonstration projects. Support attainment ofbsn degrees by PHNs Support attainment of advanced degrees (master s degree and higher) by PHNs Explore strategies to support academic practice partnerships and share outcomes with the PHN community and stakeholders 1. Explore strategies to demonstrate the effectiveness and value of promising PHN practice interventions, including pilot/demonstration projects. Evidence: North Carolina (2012) 89% of babies were born full term, 89% were born at or above at 2500 g (5.5 lbs) 44% of mothers who entered without a diploma/ged have earned one, and 26% are working toward obtaining one 73% of mothers had no subsequent pregnancies at program completion 5

6 2. Support attainment of BSN degrees by PHNs Joint Statement on Academic Progression for Nursing Students and Graduates (2012) To fulfill our shared goal to prepare a robust nursing workforce, the undersigned organizations acknowledge our full support of academic progression for nursing students and graduates. It is through the collaboration and partnering of our various organizations i that we can facilitate and inspire i the seamless academic progression of nursing students and nurses. Our common goal is a well educated, diverse nursing workforce to advance the nation s health. American Association of Community Colleges, Association of Community Colleges Trustees American Association of Colleges of Nursing, National League for Nursing, National Organization for Associate Degree Nursing. Regionally Increasing Baccalaureate Nurses (RIBN) 3. Support attainment of advanced degrees (master s degree and higher) by PHNs Advanced Practice? Advanced PHN s? DNP vs PhD? 6

7 4. Explore strategies to support academic practice partnerships and share outcomes AACN AONE Task Force on Academic Practice Partnerships: Survey Results Sample: 295 of deans; 111 of the Nurse Executives; and 32 leaders in Public Health Nursing. Findings: top partnership activity it cited by all participants i t was student clinical placements followed by joint research committees. Limitations: More than 60% of participants did not collect data on outcomes of their partnerships. The majority did not have written goals or objectives for their partnership and for those who did, these goals focused on clinical education of students. A Personal Experience: The School Nurse Case Management Project Does case management provided by school nurses: 1. Improve the health and well being of children with chronic illness? 2. Improve the academic outcomes for children with chronic illness? 3. Document the components of school based case management provided by school nurses. 4. Pilot computer technology that allows for collaboration, data collection and analysis. Funded by the Kate B. Reynolds Health Trust Definition of case management Case management is a process by which the school nurse identifies children who are not achieving their optimal level of health or academic success because they have a chronic condition that is limiting their potential. It is based on a thorough assessment by the school nurse and includes input from the family, teachers, and primary care provider. 7

8 Roles and Outcomes Process Outcomes Intervention Provided based on Case Load Goal Attainment Nursing Sensitive and Achievable Outcomes Quality of Life Parent Perception Teacher Perception Academics (Grades) Facilitators on Academic/Service Partnerships Related to Generating Research Practice Settings Written policies related to: IRB /HIPAA/FERPA Education/training required of investigators Designated person for coordination Small grant funding and identified research priorities An accurate list of: staff expertise in research specific content areas of interest. Academic Settings Meaningful dialogue about the study before it is submitted. Work for a win/win Early discussion i about: Roles/Responsibilities/ Rewards Internal Communication External Communication Timeline Budget Dissemination 8

9 Involving Students in the Generation and Use of Evidence Degree Learning Activities BSN Appraise and integrate evidence to address practice issues. Share evidence with agency professionals. MSN Apply practice guidelines to improve practice. Perform rigorous critique of evidence derived from databases to generate meaningful evidence for nursing practice. DNP Use analytic methods to critically appraise evidence. Design and implement processes to evaluate outcomes of practice, practice patterns, and systems of care. Design, direct, and evaluate QI projects that promote safe, timely, effective, efficient, equitable, and patient centered care. PhD Develop the science of nursing by conducting original research. Prepare research grants and manuscripts for publication. Assume leadership in the conduct of culturally competent scholarship to improve nursing practice. Source: AACN Essentials of Practice Doctorate, BSN, and MSN and Pathways to Excellence in PhD Programs. What is the role of professional organizations like ACHNE and APHN? Fund studies Adopt specific definitions and measures related to research Training Resources Propose studies There are only two lasting bequests we can hope to give our children. One of these is roots, the other, wings. Hodding Carter 9