Transforming Graduate Nursing Education in the Context of Complex Adaptive Systems: Implications for Master’s Curricula Dr. Gail Lis Dr. Diane Burgermeister Dr. Patricia Hanson Dr. Barbara Banfield

Background Prior MSN curricular concepts New undergraduate curriculum Critical Thinking Community Based Nursing Care New undergraduate curriculum DNP program Emergence of new documents

The Process Forming a task force Recognizing driving forces Examining key documents Emergence of themes Identification of common concepts “Goodness of Fit” of concepts with guiding documents Defining the concepts Building the framework Sharing with community of interest Members of task force reconvened to review similarities

Driving Forces Emerging health care system Change in population demographics Multiple co-morbidities Cultural diversity Number and variety of care providers Technology Reimbursement/regulatory agencies IOM challenge for nursing education Nursing to function at highest level of competency

Examining Key Documents The Essentials of Master’s Education in Nursing (2011) Graduate level QSEN Competencies: Knowledge, Skills, and Attitudes (2012) Nurse Practitioner Core Competencies (2012) The AONE Nurse Executive Competencies (2011) The Essentials of Doctoral Education for Advanced Nursing Practice (2006) The Future of Nursing: Leading Change, Advancing Health (2011)

Concepts that Emerged Relationship Based Care Creative Inquiry Leadership

Defining the Concepts Antecedents Concept Consequences Self Awareness, capacity for change, communication skills, listening empathy, respect for self and others, ability to establish and sustain relationships Relationship based care – a transformational interaction that is reciprocal between self and others to influence positive health outcomes Quality of care, collaboration, generative relationships that promote innovative solutions in partnership with patients, peers and organizations Critical thinking, appreciative inquiry, deliberative, intuitive, scientific, cultural, artistic, moral, esthetics, personal Creative Inquiry – iterative application of one or more ways of knowing to expand understanding of phenomenon in question and development of possible solutions for health care issues Dynamic outcomes, multiple possibilities, the whole greater than sum of parts Risk take, self-confidence, self awareness, visionary, communication, giver of self Leadership – dynamic and complex processes that influence the attainment of quality health care Change agent, builds trust, empower, motivate, inspire, team builder, navigator, mentor

Building the Framework Relationship Based Care Leadership Creative Inquiry Explain framework, add broken lines

Relationship Based Care Antecedents Concept Definition Consequences Self-awareness Capacity for change Communication skills Listening Empathy Respect for self and others Ability to establish and sustain relationships A transformational interaction that is reciprocal between self and others to influence positive health outcomes Quality of care Collaboration Generative relationships relationships that promote innovative solutions in partnership with others

Relationship Based Care Self awareness Open to learning from everyone Relational skills: listening, empathy, respect for others viewpoints Manage stress to balance demands of work and self-care Interaction skills Diversity of thought Innovative solutions Empowerment Decentralized interactions Generative relationships Health Professions Education and Relationship Centered Care (Tresolini & the Pew-Fetzer Task Force,1994)—illness has meaning within a person’s life story—listening skills Beach, Inui & The Relationship-Centered Care Research Network, 2006)—help patients and families express emotions, need self awareness

Creative Inquiry Antecedents Concept Definition Consequences Critical thinking, Appreciative inquiry Deliberative Intuitive Scientific Cultural Artistic Moral Esthetics Personal Iterative application of one or more ways of knowing to expand understanding of phenomenon in question and development of possible solutions for health care issues Dynamic outcomes Multiple possibilities (the whole greater than sum of parts)

Creative Inquiry An iterative process Critical thinking Expanded potential, When used the outcome is greater than the sum of each individual aspect being considered. Critical thinking Use of many “ways of knowing” phenomenon. Maybe need to be open to “unknowing”. Appreciative inquiry Collaborative, interconnected, interdependent Adaptive and diverse Intuitive Use of senses beyond the intellectual to explore problems and seek solutions. Incorporates cultural, artistic, and personal “ways of knowing” Scientific Use of the scientific method of discovery, being open to responsiveness and adaptation to the data as it emerges. Use of nursing process with willingness to explore information within each step.

Leadership Antecedent Concept Consequence Risk taker Self-confidence Self awareness Visionary communication Giver of self Dynamic and complex processes that influence the attainment of quality health care Change agent (builds trust, empower, motivate, inspire) Team builder Navigator Mentor

Leadership Dynamic and complex Embraces the idea of mindfulness Supports non linearity and unpredictability Constant change with multiple variables interacting together Expect dynamic flow of input and provide means to adapt to change Uses multiple ways of knowing (creative inquiry) Embraces the idea of mindfulness Multiple ways of knowing – assessing patterns keep an eye to the unexpected Mindfulness – used to create and sustain diverse relationships in order to solve complex health care problems

Leadership Interdependent relationships Build network of relationships that can lead to visionary transactions (relationship-based care) Transformative process Brings together all players for the common good. Uses knowledge, skills, and judgment to transform self and other (creates unity, a sense of wholeness for a collective purpose) Problem solving is a continuous constructive process

Informing Graduate Education MSN and DNP Programs Integration of concepts into program, core, and clinical outcomes Teaching strategies

Integration of Concepts Graduate Program Outcome Integrate theory, knowledge, skills, and abilities associated with creative inquiry, leadership, and relationship-based care to inform advanced nursing practice and to foster personal and professional growth

Integration of Concepts Course Specific Outcomes Core (Foundations) Analyze the associations among creative inquiry, leadership, and relationship based care and the expectations and responsibilities of nurses in advanced roles. Clinical (AGACNP) Utilize creative inquiry to design a holistic plan of care for patients across the adult-older adult age spectrum with acute exacerbation of chronic illness as well as acute and critical health care needs.

Teaching Strategies Classroom discussion Group projects Challenge thinking Student creation of exam questions and discussion Group projects Interdependent relationships Purposeful practicum selection Experience working with health care teams who model integrated approach to health care Experiences with leaders who inspire clear purpose and organizations that focus on care and healing at point of care Student support groups Reflective writing Mindfulness Case studies/Role play/Simulation Multiple ways of knowing Relational skills Difficult encounters Peer mentors/Faculty role models

Student Feedback Application of concepts Empowerment of students Expansion of sense of responsibility/accountability Sense that they have the capability to participate in the transformation of the health care system

Lis, G. A. , Hanson, P. , Burgermeister, D. , & Banfield, B. (2014) Lis, G.A., Hanson, P., Burgermeister, D., & Banfield, B. (2014). Transforming graduate nursing education in the context of complex adaptive systems: Implications for Master’s and DNP Curricula. Journal of Professional Nursing, 30(6), 456-462