An academic-health service partnership in nursing: lessons from the field

Better Together: Collaboration to Enhance the Nursing Workforce

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.

Exploring unfinished nursing care among nursing students: a discussion paper

BACKGROUND

In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations.

METHODS

A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022.

RESULTS

In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities.

CONCLUSION

Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations.

A critical realist synthesis of cross-disciplinary health policy and systems research: defining characteristic features, developing an evaluation framework and identifying challenges

BACKGROUND

Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the characteristic features of context-mechanism-outcome (CMO) configurations in cross-disciplinary HPSR, (2) develop criteria for evaluating cross-disciplinarity and (3) synthesise emerging challenges of the approach.

METHOD

The paper is a critical realist synthesis conducted in three phases, as follows: (1) scoping the literature, (2) searching for and screening the evidence, and (3) extracting and synthesising the evidence. Five databases, namely the International Bibliography of the Social Sciences and Web of Science, PubMed central, Embase and CINHAL, and reference lists of studies that qualified for inclusion in the review were searched. The search covered peer-reviewed original research, reviews, commentary papers, and institutional or government reports published in English between January 1998 and January 2020.

RESULTS

A total of 7792 titles were identified in the online search and 137 publications, comprising pilot studies as well as anecdotal and empirical literature were selected for the final review. The review draws attention to the fact that cross-disciplinary HPSR is not defined by individual characteristics but by the combination of a particular type of research question and setting (context), a specific way of researchers working together (mechanism), and research output (outcome) that is superior to what could be achieved under a monodisciplinary approach. This CMO framework also informs the criteria for assessing whether a given HPSR is truly cross-disciplinary. The challenges of cross-disciplinary HPSR and their accompanying coping mechanisms were also found to be context driven, originating mainly from conceptual disagreements, institutional restrictions, communication and information management challenges, coordination problems, and resource limitations.

CONCLUSION

These findings have important implications. First, the CMO framework of cross-disciplinary HPSR can provide guidance for researchers engaging in new projects and for policy-makers using their findings. Second, the proposed criteria for evaluating theory and practice of cross-disciplinary HPSR may inform the systematic development of new research projects and the structured assessment of existing ones. Third, a better understanding of the challenges of cross-disciplinary HPSR and potential response mechanisms may help researchers to avoid these problems in the future.

The role of academic-practice partnerships from perspectives of nursing students: A cross -sectional study

BACKGROUND

Collaborations between nursing schools and teaching hospitals are important for achieving the goals of clinical nursing education. While previous work showed that nursing students benefit from academic-practice partnerships, it is unclear how these collaborations help nursing students.

OBJECTIVE

To identify the role of academic-practice partnerships from the perspective of nursing students. Two hypothetical models based on system theory were proposed that utilized input-transformation-output processes. The input, transformation, and outputs were the "academic-practice partnership", "interaction between nurses and nursing students", and "professional self-concept and organizational socialization of nursing students", respectively.

DESIGN

This study used a cross-sectional research design.

SETTING

This study was conducted at a nursing school in Korea.

PARTICIPANTS

The participants included 243 fourth-year nursing students who were about to graduate.

METHODS

A questionnaire was used to collect data in August 2019. Path analysis was used to explore the models to determine the roles of academic-practice partnerships.

RESULTS

Two hypothetical models indicated the role of academic-practice partnership. The academic-practice partnership positively affected the interaction between nurses and nursing students, which directly and indirectly benefitted professional self-concept and organizational socialization of nursing students.

CONCLUSION

The higher perceived academic-practice partnership by nursing students, the better their interactions with nurses, professional self-concept, and organizational socialization. Therefore, nursing students should be aware of the academic-practice partnerships and nursing educators should effectively show these partnerships or collaborations to nursing students. Moreover, nursing educators should also encourage nursing students to interact with their preceptors in their practicums and, as nurses are important educators in academic-practice partnerships, they should be qualified as preceptors to teach nursing students.

Professional development outcomes associated with interdisciplinary research: An integrative review

BACKGROUND

Interdisciplinary research among health care professionals has gained importance over the last 20 years, but little is known about its impact on career development.

PURPOSE

This study examined professional development outcomes associated with interdisciplinary research.

METHODS

An integrative review was conducted using Whittmore and Knafl's framework. PubMed, Embase, PsycInfo, Web of Science, and CINAHL were searched to identify studies.

FINDINGS

Thirteen studies were included. The majority used bibliometric analyses, finding that moderate level of interdisciplinary collaboration was associated with a greater amount and higher quality of publications. Interdisciplinary publications allocated more credit (i.e., had more authors). Interdisciplinary research proposals had less funding success than single discipline proposals. Important cultural and personal aspects of interdisciplinary research (e.g., work and communication styles, research goals) have not been assessed to date.

DISCUSSION

Rigorous qualitative studies are needed to characterize benefits and challenges of interdisciplinary research to scholars and to institutions.

Service improvement in health care: a literature review

Service improvements in health care can improve provision, make cost savings, streamline services and reduce clinical errors. However, on its own it may not be adequate for improving patient outcomes and quality of care. The complexity of healthcare provision makes service improvement a challenge, and there is little evidence on whether improvement initiatives change healthcare practices and improve care. To understand the concept of service development within health care, it is necessary to explore the national context and how the NHS has adopted improvement initiatives. To equip the nursing workforce with the skills necessary to make positive change, higher education institutions have developed courses that include the topic within their pre-registration programmes. However, service improvement is a learned skill that nurses need to practise in order to become competent.

Learning in Practice: Collaboration Is the Way to Improve Health System Outcomes

Evidence suggests that it is challenging for universities to develop workplace-relevant content and curricula by themselves, and this can lead to suboptimal educational outcomes. This paper examines the development, implementation, and evaluation of Australia’s first tertiary graduate course in healthcare redesign, a partnership initiative between industry and university. The course not only provides students with an understanding of person-centered sustainable healthcare but also the skills and confidence to design, implement, and evaluate interventions to improve health service delivery. Increasing students’ application of new knowledge has been through work-integrated learning, a pedagogy that essentially integrates theory with the practice of workplace application within a purposely designed curriculum. The specific aim of this study was to examine the outcomes of the course after two years, utilizing an anonymous online survey of graduates. Sixty-two graduates (48%) completed the survey. Kirkpatrick’s four-level evaluation model was used to analyze the data. The analysis revealed high satisfaction levels in relation to the course content and delivery. Through successful completion of the innovative course, students had increased their knowledge of health system redesign methods and, importantly, the ability to translate that knowledge into everyday practice. Graduates of the clinical redesign course reported that they had been able to transfer their skills and knowledge to others in the workplace and lead further improvement projects.

Outcomes of a Critical Care Hospital-Based Fellowship for Senior Nursing Students

BACKGROUND

A partnership between four academic sites and one practice site was created to address a gap in baccalaureate nursing education resulting from the lack of pediatric and critical clinical experience. Four schools of nursing (SONs) were invited to recruit senior-level nursing students to participate in a critical care fellowship opportunity during their senior synthesis courses.

METHOD

In a mixed-method evaluation, data were collected through three questionnaires.

RESULTS

The findings indicated that the students increased their knowledge and ability in caring for critical pediatric patients. The difference in clinical hours by the SONs did not reveal significant mean differences across measures of self-efficacy, clinical knowledge, or clinical confidence.

CONCLUSION

The critical care hospital-based fellowship can be used as a partnership between a hospital and SONs to expose prelicensure students to clinical experiences and education related to pediatric critical care to decrease nursing shortages in these specialty areas. [J Nurs Educ. 2018;57(8):469-475.].

Improving Nurse Competencies for Using Evidence in Practice: A Pilot Study of the Language of Data Program

Nursing professional development practitioners are in a key position to use tools that foster nurses' interpretation of research findings for increased use of evidence in practice. An online course was developed to teach statistics as language. The feasibility and efficacy of this "Language of Data" program were examined in a pilot study with a convenience sample from inpatient settings. Recognition and interpretation of statistical symbols significantly improved after the intervention. Knowledge, confidence, and accuracy also improved. The Language of Data program may be used by nursing professional development practitioners to improve nurses' adoption of evidence-based practice by furthering their ability to translate science.

A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning

AIM

The aim of the study was to assess entry-level competency and practice readiness of newly graduated nurses.

BACKGROUND

Literature on success of new graduates focuses primarily on National Council of State Boards of Nursing Licensure Examination (NCLEX-RN) pass rates, creating a false and incomplete picture of practice readiness.

METHOD

Posthire and prestart Performance-Based Development System assessments were administered to more than 5,000 newly graduated nurses at a large midwestern academic medical center between July 2010 and July 2015.

RESULTS

Aggregate baseline data indicate that only 23 percent of newly graduated nurses demonstrate entry-level competencies and practice readiness.

CONCLUSION

New data suggest that we are losing ground in the quest for entry-level competency. Graduates often are underprepared to operate in the complex field of professional practice where increased patient acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing programs, have exacerbated a crisis in competency.

Establishing a Viable Workforce Pipeline of Primary Care Nurse Practitioners: Benefits of a Health System and Academic Partnership

Maldistribution and shortages of primary care providers, changing reimbursement structures, movement from inpatient to community-based models of care, an aging population, and health care reform lead to increased numbers of patients seeking care. All of these phenomena have a part in creating a health care landscape that requires industry leaders enlist innovative strategies to meet the health care needs of their communities. Delivery of high-quality, efficient care by qualified providers is essential for the success of any health care system. Partnerships between health systems and academic centers of learning to develop a pipeline of providers is one inventive approach that can address primary care workforce needs. The purpose of this article was to share an example of an academic/health care system partnership to address primary care workforce needs in a rural Midwestern region.

Collaborating With Businesses to Support and Sustain Research

Financial assistance is necessary for sustaining research at universities. Business collaborations are a potential means for obtaining these funds. To secure funding, understanding the process for obtaining these business funds is important for nursing faculty members. Although faculty rarely request funding from businesses, they are often in a position to solicit financial support due to existing relationships with clinical agency administrators, staff, and community leaders. The economic support received from businesses provides outcomes in nursing research, research education, academic–service partnerships, and client health care. This article describes the steps and processes involved in successfully obtaining research funding from businesses. In addition, case examples for securing and maintaining funding from health care agencies (evidence-based practice services) and from a health manufacturing company (product evaluation) are used to demonstrate the process.

Building the evidence for dedicated education unit sustainability and partnership success

AIM

To evaluate the sustainability of dedicated education units (DEUs) within an academic-service partnership.

BACKGROUND

A two-year, multisite, mixed-methods study with a randomized control trial was designed to isolate the effects of the DEU innovation on clinical education quality, teaching capacity, work life, and productivity.

METHOD

Interview data from 34 participants were analyzed for interactions and behaviors that indicated sustainability.

RESULTS

Seven themes portrayed successful participant interactions, revealing shifting roles based on mutual respect and collaboration among engaged partners working within complex adaptive systems. Relationship building and partnership achievements were confirmed as key components in DEU sustainability.

CONCLUSION

Sustainable, mature clinical education partnerships depend on implementing routinizing, reinforcing, recognizing, and rewarding activities. Unit level success relies on foundational structures that support the ongoing development of DEU clinical instructors. DEU sustainability will depend on the continual creation of new meaning for participants and the generation of new resources and results.

Barriers and facilitators to implementing delirium rounds in a clinical trial across three diverse hospital settings

Delirium occurs in more than half of hospitalized older adults with dementia, substantially worsening outcomes. The use of multiple strategies and a local opinion leader, unit champion, has cumulative and lasting effects compared with single-strategy interventions. The purpose of this article is to describe the early barriers and facilitators to rounding with unit champions in a cluster randomized clinical trial in Year 2 of a 5-year trial (5R01NR011042-02). This is a mixed-method study nested within an ongoing multisite cluster-randomized, controlled clinical trial. Descriptive and comparative statistics were collected on N = 192 nursing rounds. Qualitative data were thematically analyzed. On average, rounds lasted 25.54 min (SD = 13.18) and were conducted with the unit champion 64% of the time. This is one of the first studies to systematically address quantitative and qualitative barriers and facilitators to nurse-led delirium rounds, demonstrating the gradual adoption of an intervention in diverse clinical settings.

Development of a regional nursing research partnership for academic and practice collaborations

Background. Collaborative nursing research across academic and practice settings is imperative to generate knowledge to improve patient care. Models of academic/practice partnerships for nursing research are lacking. This paper reports data collected before and during a one-day retreat for nurse researchers and administrators from local universities and health care organizations designed to establish a regional nursing research partnership. Methods. Quantitative and qualitative methods were used to address the study aims: (1) to assess research involvement and institutional research resources; (2) to assess interest in and concerns regarding cross-institutional collaborations; and (3) to describe perceptions of the purpose of a partnership and resources needed to ensure success. Results. Participants (n = 49) had differing perceptions of accessibility to resources; participants in practice settings reported less accessibility to resources, notably grant development, informatics, and research assistant support. Participants were interested in collaboration although concerns about conflict of interest were expressed. Four themes related to partnering were identified: harnessing our nursing voice and identity; developing as researchers; staying connected; and positioning for a collaborative project. Conclusion. Academic-practice research collaborations will become increasingly important with health care system changes. Strategies to develop and sustain productive partnerships should be supported.