Advanced Pathology Week 4

DISCUSSION: THE DNP-PREPARED NURSE AND THEIR COMMUNITIES OF PRACTICE

Journal of Professional Nursing

Volume 49, November–December 2023, Pages 21-25

Research, Practice and Teaching United: Implementing AACN Academic Guidelines in a Community Based Behavioral Health Setting

Author links open overlay panelRachel H. Adler PhD, APRN, PMHNP-BC, AGNP-C, Cindy Sickora DNP, MS, RN, FAAN

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Highlights

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The achievement of nursing student competencies and nursing faculty development are complementary endeavors.

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The Boyer Model undergirds faculty and student work by bridging the academic pillars of education, practice and research.

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Faculty research can enhance student learning when students are provided an opportunity to participate.

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Community engaged scholarship facilitates student learning.

Abstract

The Essentials: Core Competencies for Professional  Nursing Education  (2021) published by the American Association of Colleges of Nursing encourages bridging the gap between education and practice and continues to support the importance of providing clinical educational experiences in diverse settings. Another AACN document,  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement (2018), strongly encourages nursing faculty to engage in scholarship, a tradition that is integral to academic positions. This article demonstrates how these two important documents, one aimed at student competencies and curriculum and the other at nursing faculty development, can be connected to the mutual benefit of faculty and students alike. By revisiting Boyer's model of scholarship, the authors offer a new look at the integration of experiential learning that includes clinical practice, research, and competency-based education. The case study demonstrates that students and faculty can meet the tripartite mission of nursing education by creatively engaging in a community-based setting where they actively participate in all three pillars of academic nursing.

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Introduction

The Essentials: Core Competencies for Professional  Nursing Education  (2021) published by the American Association of Colleges of Nursing (American Association of Colleges of Nursing, 2021) defines domains and competencies that embody nursing as a  profession . The document is key for building curricula that effectively prepare student nurses to be competent nursing professionals. Another AACN document,  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement (2018), strongly encourages nursing faculty to engage in scholarship, which it defines as, “the generation, synthesis, translation, application, and dissemination of knowledge that aims to improve health and transform health care (American Association of Colleges of Nursing, 2018, pg. 2),” recognizing that this is a tradition that is integral to academic positions in most other fields. This article shows how these two important documents, one aimed at student competencies and curriculum and the other at nursing faculty development, can be connected to the mutual benefit of faculty and students alike.

As an art and science (Chen, 2022; Palos, 2014; Weaver, 2021; Younas & Parsons, 2019) nursing has spent decades working towards integration of education, research, and practice in the academic setting to develop the profession (Burns & Foley, 2005; Camiah, 1997; Francis-Baldesari & Williamson, 2008). Since the 1970's nursing has put a great deal of effort into nursing science contributions and evidence-based practice initiatives (Patelarou et al., 2020). Engagement in scholarship is critical both for the continuous development of the professional science and to educate the next generation of nurses to provide evidence-based  nursing care . Integration of education, research and practice is becoming the required norm in nursing education. As far back as the AACN 2008  The Essentials of Baccalaureate Education for Professional Nursing Practice, integration of education, practice and research/scholarship was identified as critical to enable graduates to practice within complex healthcare systems and “assume the roles: provider of care; designer/manager/coordinator of care; and member of a profession” (American Association of Colleges of Nursing, 2008, pg. 1).

Nursing, unlike liberal arts and other science disciplines, is a practice profession and has relied heavily on the clinical component of education as opposed to scholarly endeavors. In the liberal arts, there is less often an applied or professional aspect to a discipline. In nursing, there has been a blurring between practice and academic nursing scholarship. Some have defined the relationship of scholarship and practice in nursing as a contentious one (Nahm et al., 2023) and integrating the pillars of academic nursing has long been a challenge (Letcher, Massey, Nelson, & Elverson, 2020; Mittelman, 2010). This problem is compounded by the national nursing faculty crisis and the lack of doctorally prepared  nurse educators  who understand the importance of ongoing creation of new knowledge (American Association of College of Nursing, 2022). Findings regarding the importance of practice and research integration are robust (Curtis, Fry, Shaban, & Considine, 2017; Hansen et al., 2022; Jones, 2015; Menzies, Emms, & Valler, 2021) with a body of literature describing teaching methods as they relate to practice, especially in the community (e.g., Adams, 2020; Dexter, 2021; Fong, Yee, Ng, Chow, & Lo, 2022; Mumba, Kaylor, Townsend, Barron, & Andrabi, 2022; Yoong, Liao, Goh, & Zhang, 2022). The current shortcoming is integration of all three pillars of academic nursing which is basic to the implementation of both the  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement and  The Essentials: Core Competencies for Professional Nursing Education. The authors contend that employing the Boyer (1990) model of scholarship as described herein, supports both documents and provides a unique opportunity for faculty to meet the goal of integrating practice, research and education. This approach provides a robust learning opportunity for students, meeting competency-based nursing education metrics, and allows both students and faculty to actively participate in the tripartite mission of nursing academia.

ACCN Vision and the Boyer Model.

AACN's  The Essentials: Core Competencies for Professional Nursing Educationstrongly encourages  bridging the gap between education and practice ( American Association of Colleges of Nursing, 2021, p. 1) with all 10 domains addressing integration of practice into diverse clinical settings, applying evidence to nursing care across settings and evaluating nursing education outcomes through competencies that reflect an understanding of scientific inquiry. The domains are broad categories that identify areas where student nurses must demonstrate competency in the art and science of the profession. Bridging the scholarship gap between education, research and practice can often be a challenge for faculty to model for students. At the same time, the AACN's  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement sets a high mark for nursing faculty, as they are encouraged to broadly envision their scholarship by engaging in activities that encompass all three pillars. Yet, it is not often that faculty can participate, and showcase for students, all three pillars simultaneously.

Ernest  Boyer's, 1990 work provides a segue and a bridge between academic pillars, contending that there is an environment that transforms the definition of productivity in the academic setting. Boyer's model states that scholarship takes place in each of the academic missions: teaching; practice; and research. The model provides exceptional relevance to  The Essentials: Core Competencies for Professional Nursing Education which recommends weaving the academic pillars through nursing curricula. It is also significant to  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement, as faculty are provided an opportunity to integrate the pillars demonstrating the “scholarship of discovery” (see Fig. 1) through teaching, practice, and research. Although Boyer's model has been used to professionally reward academic faculty for work outside of traditional research (Crow et al., 2018) in the case described here, the model also demonstrates its impact as a prototype for teaching undergraduate student nurses how to integrate the pillars by providing care to an  underserved population  and for implementing a study that contributes to what we know about the mental health needs of homeless veterans. This case study offers nurse educators the opportunity to cultivate clinical opportunities that demonstrate the breadth of nursing education. In this case, the undergraduate students participated in most aspects of the early stage of the research project experiencing, firsthand, the influence of an integrated education model.

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Fig. 1. The Boyer model of faculty scholarship in nursing.

Background

Case study: Nursing scholarship at a local non-profit agency

As faculty members at the University of Texas Health Science Center at San Antonio School of Nursing (SON) the authors are expected to contribute to the tripartite mission of the SON making contributions to either education, practice, or research. Boyer's model supports the success of the nurse-teacher-scholar to achieve success moving through academic ranks by scholarship productivity in any one of the pillars. The authors contend that it is possible to achieve multiple scholarly endeavors simultaneously through research, education and practice activities while achieving outstanding outcomes for students, patients, and the science of nursing.

The principal investigator (PI) for this project is a psychiatric  mental health nurse practitioner (PMHNP) with a doctorate in cultural anthropology. The PI's research interest and expertise is in men's mental health, especially suicide prevention. The PI's teaching assignments include  psychiatric nursing  and population health, each of which can be taught in community-based settings. In addition to teaching and performing research, the PI maintains a clinical practice as a psychiatric mental health nurse practitioner (PMHNP). The clinical practice opportunity is part of the SON Faculty Practice, Clinical Enterprise. The practice site is located within a community organization that has multiple programs serving men, including a halfway house for former federal prison inmates, a residential rehabilitation program for homeless veterans, and an  outpatient clinic  that serves the residents (both federal bureau of prisons inmates and veterans). Practice occurs one day per week, providing an opportunity to become familiar with the organization, community resources, and the patient population. Learning early in the partnership that the suicide death of a homeless veteran created program set-backs the PI, an expert in men's suicide, set-out to design a research project focused on suicide prevention. Engaging students at the site as part of their population health clinical experience provided the final academic nursing opportunity to educate students at a site where one is practicing and performing research. The experience meets several domains in  The Essentials: Core Competencies for Professional  Nursing Education , specifically: Knowledge for Nursing Practice (Domain 1); Person-Centered Care (Domain2); Population Health (Domain 3); Scholarship for Nursing Practice (Domain 4); Inter-Professional Partnerships (Domain 6) and Professionalism (Domain 9). Importantly, it meets these domains while demonstrating the integration of the tripartite academic mission of nursing scholarship as embodied in  Defining Scholarship for Academic Nursing Task Force Consensus Position Statement.

Method

The course

The course is the clinical component of Population Focused Health, a senior level community health course offered to both traditional and accelerated BSN students. It is worth two semester hours of credit. Students must complete ninety hours in the clinical setting. The course itself is designed to embody  The Essentials: Core Competencies for Professional Nursing Education as course outcomes are linked to domains within the syllabus. Table 1 lists relevant course outcomes with the specific domains from  The Essentials: Core Competencies for Professional Nursing.

There are set assignments for all clinical sections, and these are completed outside of clinical time. How students spend their time while in the clinical setting is determined by each instructor. Some instructors have students take vital signs, provide  vaccinations  or conduct health screenings, for example. As long as the activities are directly related to course outcomes, there is great flexibility in how instructors can structure student clinical experiences.

In the case presented here, the professor selected as the main clinical site a location where she both practices and was initiating a research study, and the clinical activities involved students participating in planning and executing early stages of the research. While this was one site among many (another clinical site that semester was an emergency homeless shelter), the ability of individual faculty to choose the clinical experiences that enable students to meet course outcomes is key to the success of this enterprise, as faculty can opt for sites that will enhance their own scholarship.

The study

The purpose of the study, which was approved by the university's Institutional Review Board (IRB), was to assess the needs of the homeless veterans' program at a local non-profit organization, with the intention of developing future research that will translate findings into clinical practices that improve services and health outcomes for their clients. The study also contributed new knowledge about suicide and veterans. Homeless veteran clients are particularly vulnerable because not only are they encountering housing insecurity, but they are also at high risk for suicide as most embody multiple risk factors such as male gender, veteran status, unemployment, family dysfunction, a history of substance abuse and  psychiatric diagnoses  that may involve post-traumatic stress disorder (PTSD) and depression. The first phase of the research was a needs assessment, whereby the partner organization staff were interviewed to find out their perspectives about the existing program and how it could be improved or otherwise changed. In the second phase, veteran consumers were interviewed. The research project was designed with direction from the Population Focused Health course objectives, as the students would be engaged in clinical hours at the facility and assist and observe the first phase of the research.

The research proposal, which was successfully funded by the Nursing Advisory Council of the School of Nursing at the University of Texas Health Science Center at San Antonio listed the following objectives:

1. To establish a more comprehensive collaboration between the veterans program and the university's SON, that includes research as well as practice and teaching.

2. To involve the university's SON undergraduate students in the development of a community engaged research project as part of their senior year experience and include  SON graduate students  in faculty-initiated research.

3. To assess the needs of the veterans program with the goal of developing translational research projects to address these needs. The research will add to nursing science to improve nursing practice and provide the organization with effective solutions to programmatic problems with which they have identified.

The project brought the classroom to the community by allowing population health students to actively participate in phase one. The research endeavor created a rich learning environment for students and made course content relevant to them as they engaged in active learning about both population health and research methods. In this work the PI was acting not only as researcher, but also as teacher and provider. This integration of  nurse educator  roles allowed students and the community to benefit from nursing scholarship meeting the requirements of  The Essentials: Core Competencies for Professional Nursing Education and establishing a fresh new look at the Boyer model for academic scholarship.

There were ten students in the clinical section. To prepare the students for their clinical experience at the non-profit organization, the professor (PI) organized an onsite orientation, in which staff presented the goals and mission of their various programs. The research proposal was also made available for students to read, so that they understood the project and how they would be participating. Students reacted positively and were excited by the prospect of observing and participating in research firsthand. Finally, students were taught about qualitative methods, including ethical principles such as maintaining confidentiality, data collection techniques and analysis.

Findings.

During several visits to the organization, four staff members were interviewed. For each interview, two to three students observed. Students were asked to formulate follow up questions, and at the end of each interview they were afforded the opportunity to ask their own questions of the interviewee. Immediately following each interview, the faculty and students discussed the highlights. Students were remarkably perceptive and shared important insights about the interviews.

The interview guide included the following questions:

1. What are the goals of the veterans Program?

2. How is the organization meeting those goals?

3. How is the organization not meeting those goals?

4. What are your personal goals for the program?

5. What recommendations do you have for improving services here?

6. In what ways is the veterans program addressing suicide risk?

7. In what ways can the veterans program improve its services as it pertains to suicide risk?

Students who were not attending interviews, conducted participant observation with the veterans in the common area where residents can play games, eat snacks and participate in community activities. Students sat and conversed with the veterans, with the goal of finding out their thoughts about the program. During the post-conference, students shared their observations with the professor and the rest of the class. This provided them with another opportunity to practice research skills by presenting the data that they collected and helped the nurse-scholar better understand the perspective of the veteran residents. The veterans genuinely enjoyed interacting with students which made the intervention a positive experience for all.

At the conclusion of the course students evaluated their experiences. Students shared that they enjoyed and valued the opportunity to observe and participate in faculty research. These students were in the accelerated BSN program and earn a second bachelor's degree. A few expressed a desire to pursue graduate work in the future.

Discussion

The Essentials: Core Competencies for Professional Nursing Education is a competency-based education model recently implemented by schools of nursing around the country. Students are expected to demonstrate competencies to complete curricular requirements. The course highlighted here provided students the opportunity to demonstrate core competencies meeting five domains of the document. First, the students observed and engaged with a vulnerable population of veterans experiencing multiple levels of mental health disorders addressing the  Population Health Domain (III). Next, students had the opportunity to interact on an individual level with the clients in a non-acute setting, alongside other health professionals, addressing  the Person-Centered Care (I), Interprofessional Partnerships (VI) and Professionalism Domains (IX). Finally, students learned firsthand about conducting research with vulnerable populations by actively participating in the research process, addressing the  Scholarship for the Nursing Discipline (IV).

The students had the opportunity to be part of the creativity and hard science of research activities from IRB application through collection of data. They learned about research with vulnerable populations and the necessary protection that must take place in the process. Hence, this experiential learning opportunity provided students the ability to demonstrate competencies in the multiple domains of  The Essentials: Core Competencies for Professional Nursing Educationand provided the professor/PI to actively practice, teach and implement research. The specific competencies and sub-competencies met by students in the course are found in Table 2. These competencies were assessed and evaluated in the