1. 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

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

3. 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

4. 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

5. 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)

6. Concepts that Emerged Relationship Based Care Creative Inquiry
Leadership

7. 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

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

9. 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

10. 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

11. 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)

12. 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.

13. 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

14. 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

15. 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

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

17. 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

18. 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.

19. 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

20. 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

21. 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),