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Peering into the Post-COVID Nursing Curriculum

Peering into the Post-COVID Nursing Curriculum

Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACN Essentials further integrate into nursing curriculums.

But what about the content of the curriculum? 

Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking. 

Nursing education after COVID

Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school

A Look at Nursing Education After COVID

Telehealth

Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.

Systems Thinking 

Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”

More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.

Emphasizing Leadership

In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”

Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.

“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”

Innovation

Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”

Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”

QSEN and Competencies 

With the latest AACN Essentials, there is a drive for competencies in nursing education, notes Dolansky. The Essentials: Core Competencies for Professional Nursing Education, approved by the AACN in April 2021, calls for a transition to competency-based education focusing on entry-level and advanced nursing practice.  

While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.

Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.” Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.

“Own Their Competency”

In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.

As Covid Shifts to Endemic, Nursing Educators Reevaluate the Curriculum

As Covid Shifts to Endemic, Nursing Educators Reevaluate the Curriculum

For nursing education in a post-pandemic landscape, technologies such as simulation will continue to help educate students. And while plenty of people are interested in becoming nurses, not enough nurse educators may be available, and limited access to clinical placements may hinder those who want to enter the profession.

Remote teaching and simulations: what should we retain post-Covid?

Bimbola F. Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP, associate professor and associate dean, master's program, U Maryland School of Nursing. During the pandemic, increased use of technology helped nursing students at the University of Maryland School of Nursing meet their competencies, according to Bimbola F. Akintade, Ph.D., MBA, MHA, ACNP-BC, NEA-BC, FAANP,  associate professor and associate dean, master’s program at the school. Because students couldn’t physically care for patients in the hospital as part of their clinicals, the university transitioned to simulation. Using its 25 simulation labs and simulation team, the school made greater use of both high-fidelity simulations in the lab, as well as asynchronous virtual simulation.

In entering a more endemic stage, the university is now evaluating what courses should remain online. The school, says Akintade, is revising its entire curriculum based on the new Essentials from the American Association of Colleges of Nursing (AACN). “This is a perfect time,” he says, “while we’re revising the curriculum, to identify what courses could stay online to create additional flexibilities for our adult learners.” The Essentials: Core Competencies for Professional Nursing Education provides a framework for preparing individuals as members of the discipline of nursing.

“For a long time, we’ve convinced ourselves that there was this primary way of teaching, of education dissemination to students. And the pandemic turned that on its head. Certain courses that we believe could not be effectively taught in a virtual space could be because we did it. Now we’re charging ourselves to go back and reevaluate how we taught our courses and identify what courses could successfully remain virtual.”

The Maryland State Board of Nursing, says Akintade, had allowed up to 50% of clinical experience to be done through simulation. The school, taking a more conservative approach, kept that to 10% to 20%. That increased significantly during the pandemic, he notes.

“Now we’re being intentional about reevaluating that to determine how much of our clinical experience for students could be accomplished through simulation,” he says. “We anticipate that we will do more simulation than we did pre-pandemic.”

Finding faculty

In an endemic healthcare landscape, finding nursing educators and clinical placement spots may pose a challenge. Clinical placement spots, says Akintade, who has been at the school since 2011, may be the more rate-limiting factor in growing a nursing education program.

Though interest in baccalaureate and graduate nursing programs is strong, thousands of qualified students are turned away from four-year colleges and universities each year, notes an AACN press release about the association’s just-released “Annual Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs.” Given the persistent shortage of nurse faculty, AACN remains concerned that 14,743 applications were turned away from graduate programs, which may further limit the pool of potential nurse faculty, according to the release. The primary barriers to accepting all qualified students at nursing schools, says the release, continue to be insufficient clinical placement sites, faculty, preceptors, and classroom space, as well as budget cuts.

The nursing shortage, says Akintade, has not helped matters, with older nurses retiring and some younger nurses leaving the profession.  “The response is growth,” he says. “We recognize the need for additional nurses in the state of Maryland. So our baccalaureate program is growing.”  The university has a target of enrolling over 500 nursing students a year in either the BSN program or entry-into-practice master’s program.

No lack of interest

One unalloyed bright spot from the pandemic is new interest in healthcare professions. The AACN survey finds that student enrollment in entry-level baccalaureate nursing programs increased by 3.3% in 2021. Growth was seen in both baccalaureate programs and doctor of nursing practice (DNP) programs.

The pandemic has exposed many individuals who never considered becoming a healthcare professional to that idea, suggests Akintade. “We’ve seen an increase in the number of our applicants even through COVID.”

“We’ve been the sung and sometimes, unfortunately, the unsung heroes through the pandemic. Nursing as a profession was really put on the forefront through the pandemic.”

AACN Announces New Leadership and Resilience Initiative

AACN Announces New Leadership and Resilience Initiative

The American Association of Colleges of Nursing (AACN)  is embarking on an initiative focused on building leadership capacity in new nurses with a special emphasis on developing essential skills in resilience, self-care, and well-being. The two-year project, titled A Competency-Based Approach to Leadership Development and Resilience for Student Nurses, was launched with funding from the Johnson & Johnson Foundation in partnership with the Johnson & Johnson Center for Health Worker Innovation.

“As we move beyond the pandemic and consider the future of health care, we arrive at a pivotal time in nursing when new ideas and energy are driving us toward a new way of preparing nurses for contemporary practice,” said Dr. Deborah Trautman, AACN President and Chief Executive Officer. “We applaud Johnson & Johnson for helping us develop the next generation of nurse leaders with the skills needed to adapt work environments to prioritize self-care, healthy behaviors, and well-being.”

A New Standard for Nursing Education

AACN President Deborah Trautman, PhD, RN, FAAN.In April 2021, member schools affiliated with AACN voted to endorse The Essentials: Core Competencies for Professional Nursing Education, which outlines a new model and framework for professional nursing education using a competency-based approach. Moving to implement the new Essentials presents a unique opportunity for schools of nursing to infuse innovation into nursing curriculum to better prepare nurses to thrive across practice settings. The new standards call for preparing nurses with specific competencies related to leadership development, professionalism, emotional intelligence, and developing wellness and resilience for themselves and others.

Through this new initiative, AACN will convene an expert advisory group to develop new learning strategies and assessment measures related to personal, professional, and leadership development, including activities and self-reflection that foster health, resilience, and well-being. Once developed, AACN will pilot test the new content at 10 schools of nursing, assess the impact on student competency, disseminate results to all nursing schools, and offer faculty development opportunities to assist with new content integration into curriculum.

“Academic nursing leaders recognize that developing leadership and resilience capacity among new nurses is essential to effective nursing practice,” said Dr. Trautman. “We are excited to have this opportunity to elevate nursing’s role in leading innovation while sustaining provider well-being and impact.”

Expert Advisory Group Formed

To guide this new initiative, AACN has convened an expert group of nurse faculty and content specialists to develop new curriculum and learning strategies for building competencies essential to leadership and fostering resilience, wellness, and self-care. This work entails designing innovative clinical learning experiences where students can practice these new skills. Outcomes will include the identification of effective learning assessment measures consistent with the competency-based approach to learning advanced in the new Essentials. Members of this expert group include:

Michael Ackerman, DNS, RN, FCCM, FNAP, FAANP, FAAN
Professor of Clinical Nursing and Director of Master of Healthcare Innovation Program
The Ohio State University College of Nursing

Adejoke Bolanle Ayoola, PhD, RN, FAAN
Department Chair and Professor
Calvin University

Sherry S. Chesak, PhD, MS, RN
Assistant Professor of Nursing
Mayo Clinic

Janie Heath, PhD, APRN-BC, FNAP, FAANP, FAAN
Dean and Warwick Professor of Nursing
University of Kentucky College of Nursing

Teri Pipe, PhD, RN
Professor and Dean Emerita
Founding Director, ASU Center for Mindfulness, Compassion and Resilience
Edson  College of Nursing and Health Innovation
Arizona State University

Allison P. Squires, PhD, RN, FAAN
Associate Professor and Director, Florence S. Downs PhD Program in Nursing Research and Theory Development
New York University Rory Meyers College of Nursing

Deborah Stamps, EdD, MBA, MS, RN, GNP, NE-BC
Executive Vice President Chief Nursing Education and Diversity Officer
Rochester Regional Health

Cheryl Woods Giscombe, PhD, PMHNP-BC, FAAN
LeVine Family Distinguished Scholar of Quality of Life, Health Promotion, and Wellness and Associate Dean, PhD Division & Program
The University of North Carolina at Chapel Hill School of Nursing

AACN will provide regular updates on this initiative to the academic nursing community as the work moves forward. For more information, please contact Kathy McGuinn, AACN’s Director of Interprofessional Education and Practice Partnerships, at [email protected].

NP Introduces New Addiction Competencies Toolkit for Nursing Curriculum

NP Introduces New Addiction Competencies Toolkit for Nursing Curriculum

Drug overdose deaths in the U.S. reached a grim milestone in 2020. The CDC estimates  that 93,331 people died, representing the highest number of deaths recorded and a 29% increase over 2019. Opioid-involved overdose death rates rose 37% in 2020, with synthetic opioids involved in a majority of fatalities. Additionally, overdose deaths involving cocaine and methamphetamines also increased in 2020.

The COVID-19 pandemic has been a main contributor to this loss of life, but a major barrier has been and continues to be, a lack of access to treatment. Data from the Substance Abuse and Mental Health Services Administration shows that in 2019, only 1.5% of individuals aged 12 years and older received any form of substance use treatment.

Though there isn’t an evidence-based medication to treat all forms of substance use disorder (SUD), three do exist for opioid use disorder (OUD): methadone, buprenorphine, and naltrexone. Only half of clinicians with waivers to prescribe buprenorphine, however, actually do so in practice, according to a 2019 Pew study. Other research has shown that only 50% of nursing schools in the U.S. include education related to SUDs in their curriculums, and some findings are even direr.

Kristin F. Wason, NP, who works at Boston Medical Center‘s Office-Based Addiction Treatment (OBAT) Training and Technical Assistance (TTA), has been treating patients with SUDs for 12 years and recognizes the need for more addiction education in both nursing and medical schools. This is why she and her colleagues published the Addiction Nursing Competencies in The Journal of Nursing Administration. The first of its kind, the comprehensive toolkit outlines the framework and clinical skills necessary to educate, train, and evaluate nurses in the addiction space.


Article republished courtesy of Boston Medical Center’s HealthCity. To sign up for regular updates, register here.


HealthCity recently spoke with Wason about what drove the creation of this toolkit and the steps needed to increase medication access for SUD.

HealthCity: Why are nurses so critical in the care continuum for patients with addiction?

Kristin F. Wason, NP, Boston Medical Center

Addiction specialist Kristin F. Wason, NP, Boston Medical Center

Kristin F. Wason, NP: Substance use disorders are chronic medical conditions that are far too often life-threatening or fatal, despite safe and effective treatment options. Additionally, data shows that due to an increased risk for developing other chronic health conditions and acute care needs, persons with substance addiction present to the medical system more often than the general public—often for reasons other than primarily seeking treatment for their use disorder.

Nurses are a diverse group of frontline workers who are often the first healthcare provider that a person with SUD encounters when they present for care. Unfortunately, there continues to be a lack of addiction education within many nursing programs, leaving many nurses unprepared to appropriately screen and care for persons with SUDs. That is what motivated our team to develop this toolkit to support both individual nurses as well as nursing managerial teams in their efforts to build and evaluate nursing addiction care.

This toolkit, called Addiction Nursing Competencies, supports a holistic approach to patient care, focusing on an individual’s strengths, motivation, and personal definition of recovery. Paired with tools such as medications for addiction treatment and harm-reduction strategies, these competencies aim to enable nurses to safely and effectively deliver care to persons across the spectrum of the substance addiction from active use to long-term recovery.

HC: We know that keeping patients with SUD engaged in care can lead to additional improvements in health outcomes. Can you please describe these benefits?

KW: By engaging persons with SUD into care and providing education about harm reduction, we could also expect improvement in commonly co-morbid health conditions, such as HIV, hepatitis C, skin and soft tissue infections, and improvement in chronic health conditions, such as hypertension, diabetes, and respiratory illnesses.

Programs, like BMC’s OBAT, that are integrated within our primary care and other health systems help promote access to a variety of resources, such as family planning services and preventative healthcare. Our nursing teams have been vital in ensuring patients are adequately immune to hepatitis A and B, in particular, by checking titers and providing vaccines during addiction treatment appointments. We are also able to help coordinate and facilitate behavioral health treatment services within our institution and community.

HC: You’ve been treating patients with substance use disorders for a majority of your nursing career. Why did you choose to go into this specialty?

KW: I grew up within a community that very much struggled, and continues to struggle, with substance use and addiction. I have always carried a strong belief and understanding that good people are impacted by addiction and deserve care.

Upon graduating, I was not familiar with the role that nurses could have in caring for persons with addiction. It always seemed like a field that was more focused on “counselors” or 12-step programs.

Within a few days of working with the BMC OBAT team, I felt at home. The way the patients opened up and shared such intimate details about their lives was fascinating. The patients encouraged me to ask questions as they clearly enjoyed teaching me, a new young nurse, about the dangers of the drugs they were using, how they were using them, and all of the work that they were doing for their recovery. Many had been to numerous detoxes, meetings, counseling, residential programs, and psychiatric facilities. They had tried it all. They shared the barriers to recovery, and there were, and continue to be, many.

Some patients also said that the best treatment was finding a program, like OBAT, that provided ongoing treatment, including medication, which allowed them to feel normal, function during the day, and live their own life within their community safely and proactively. The medication for addiction treatment and care team support provided a form of relief and freedom.

I have been fortunate to work in the field of addiction for nearly my entire nursing career and it has been incredibly rewarding to partner with patients on their journey to recovery. Some patients I met immediately post-incarceration, who are still connected to OBAT, are now employed, housed, and maintaining long-term recovery. Many of my patients have become parents over the years and now bring their kids to our visits. It’s incredible.

HC: It’s clear that stigma still plays a role in both patients with SUD accessing treatment as well as clinicians’ willingness to treat patients struggling with addiction. How will publications like this help reduce the stigma on both sides of this equation?

KW: Substance use disorders are complex, chronic medical conditions that have been historically viewed as social rather than medical problems. Persons with substance use disorders deserve empathetic, respectful, evidence-based care for their condition, and the current lack of training and knowledge by clinicians and providers is a significant barrier to accessing care.

The Addiction Nursing Competencies aims to provide nurses, who are frontline staff trained in acute and chronic disease management, with the clinical and education guidance to provide safe and effective care to persons across the spectrum of substance addiction from active, ongoing use to sustained recovery.

While progress has been made, stigma still exists related to evidence-based care, particularly centered around ongoing medication treatment and harm-reduction strategies. We have a lot of work to do in terms of educating our workforce and the public about the benefits of comprehensive addiction treatment for all patients across the spectrum of substance use and recovery.


This interview has been condensed and edited for clarity. The original version of this article can be found at the HealthCity website.