Professional Documents
Culture Documents
Integration of Best Practice Guidelines (BPGs) Into an Undergraduate Nursing Curriculum Muhammad Arsyad Subu
November 23, 2011
INTRODUCTION
The RNAO launched the BPGs program in November 1999. The purpose of this program is to support Ontario nurses by providing them with
practitioner and patient decisions about appropriate healthcare for specific clinical (practice) circumstances (Field & Lohr, 1990).
Now,
44
guidelines,
Toolkit
and
Educator's
Resource
to
support
implementation; and 16 are available in Chinese, Italian, Japanese, and Spanish in addition to English and French (RNAO, 2011).
In Excellent Care for All Act, Bill 46 (Chapter 14 Statutes of Ontario, 2010).it is
a legal requirement that healthcare organizations consider the use of the best
available scientific evidence in healthcare in Ontario.
outcomes, impacts patient referrals, creates partnership & offers cost savings (Brouwers, et al, 2004; Campbell, et al, 2010; Coutts, 2003; Delvin, et al, 2002); Ellis, et al, 2007; Higuchi, et al, 2011; Hogan &
the implementation of BPG in clinical settings; but after an intensive literature search, nothing has been said that BPGs are systematically integrated in an
RESEARCH QUESTION
How the BPGs recommendations are integrated in
overall curriculum design (theory and clinical courses) in undergraduate nursing program?
What are the barriers and facilitators of BPGs
curriculum?
How the curriculum changes have been sustained
CONCEPTUAL FRAMEWORK
NHS sustainability model will be used as a framework to guide the
study.
It is developed by NHS Institute for Innovation and Improvement in UK
& widely used of diverse disciplines around the world (Australia, Chile, Italy, Jamaica, Malta, South Africa, UK and the USA).
It is intended to provide a user-friendly practice-based guide to the key
factors that need to be considered for sustained organizational change (NHS, 2010).
It consists of ten factors related to:
SUSTAINABILITY
Sustainability is the degree to which an innovation continues
to be used. It is when new ways of working and improved outcomes become the norm and the continuation of
2004) .
LITERATURE REVIEW
Nursing must be the discipline that uses knowledge and evidence from multiple
knowledge development in educational & clinical practice (Higuchi et. al., 2006, Ritchie, et. al., 2010, de Cordova, et. al., 2008, Eaton, et. al., 2007, Miner Ross
functions of the Council are to promote healthcare that is supported by the best available scientific evidence by making recommendations to health care organizations and other entities on standards of care in the health system, based on or respecting clinical practice guidelines and protocols, making recommendations, based on evidence and with consideration of the
setting;
Identify facilitators and driving forces to integration of BPG content;
overcome them;
Identify partnerships for BPG education; Facilitate the integration of BPG content into learning events; Identify & allocate resources necessary for a successful learning
event;
Plan for content and develop a learning plan; and Plan for contingencies
strategy for a practice setting, is the overall plan for the education of learners in the institution or program
BPGs integration in curriculum must be planned in relation to present
content and context, experience and motivation. & possible disruptions require a contingency plan.
The integration of BPG into curricula will promote student acceptance
of the philosophy and underlying BPGs values as a natural part of their approach to nursing profession.
However, it is still unknown how the BPGs recommendations are
used.
curriculum undergraduate program to ensure students competencies (Ciliska, 2005, Melnyk & Fineout-Overholt, 2011; Mazurek- Melnyk, 2011).
Plan for BPG integration in theory and clinical courses (the type of
create an impetus for change and allow integration of BPG and identify potential barriers in BPG implementation & strategies to overcome them (RNAO, 2005).
(learned in basic education, in service exposure, post graduate courses with BPG in curriculum); and staff without previews BPG knowledge.
Identify facilitators and potential barriers in BPG implementation &
been an explicit concern to the discipline and profession of nursing for decades (Newton, 2009).
Barriers to effective use of research include the gap between research
and practice goals; the relevance or perceived relevance of research; poor access to research or not having time to absorb it; and researchunfriendly organizational settings (Hemsley-Brown, 2004).
The most commonly reported barriers of BPGs implementatuion in
clinical settings are: (1) staff time, workload and resource constraints; (2) lack of access to equipment and resources; and (3) staff resistance to change (Ploeg, et al., (2007).
change champions, local facilitators, local leaders and/or specialist nurses; (2) staff training, education, and problem solving related to guidelines; (3) strong unit or organizational leadership; & (4) collaboration with multidisciplinary teams (Ploeg, et al., 2007).
The RNAO (2005) predicted some facilitators in any setting: 1)
accreditation expectations; 2) professional practice standards: 3) changes to entry practice requirements; 4) increased awareness and appreciation of evidence-based practice (EBP); 5) social accountability for quality outcomes; and 6) fiscal accountability for
quality outcomes.
investigation of the type that is normally necessary to answer (how, what and why) questions (Yin, 2004, 2008; Clardy, 1997; Shavelson & Townes, 2002).
It investigates a phenomena within its real life context, especially when the
boundaries between phenomenon and context are not clearly evident (Merriem, 1998).
Stake (1995): intrinsic (understand the particulars of a case); Instrumental
information than what is available through other methods (Neale, Thapa, &
Boyce, 2006).
research: Plan, Develop Instruments, Train Data Collectors (if necessary), Collect data, Analyze data, Disseminate
cases and determine data-gathering and analysis techniques, prepare to collect data, collect data in the field, evaluate and analyze the data, and prepare the report(Merriam, 1998).
questions) It used when: the type of research question is typically to answer how, what or why questions (Yin, 2008; Clardy,1997; Shavelson & Townes, 2002; & Merriam, 1998).
A case study provides rich and significant insights into events and
behaviours and contribute uniquely to our knowledge of individual, organizational, and social, phenomena (Yin, 2004).
It provides descriptive details about how the workplace function, and
increases understanding of a particular phenomenon and a holistic view of a situation (Yin, 2008).
PROCEDURE:
Inclusion criteria: Site or setting is a nursing program that has integrated BPG recommendation in undergraduate curriculum (theory and clinical courses).
Purposive sampling - Purposive sampling is popular in case study qualitative research (subjects are selected because of some characteristic ; i.e. snowball or chain - identifies
cases of interest from people who know, people who know what cases are information-rich,
that is, good examples for study, good interview subjects (Patton, 2002) SETTING:
The BPGs program has been implemented in some nursing schools in Canada and the United States. This study will be conducted at one nursing school that has implemented BPGs in undergraduate nursing curriculum in Ontario .
PARTICIPANTS:
Participants in this study will be the faculty, program leaders (administrative leaders),
clinical partners representative, and students.
DATA COLLECTION METHOD A case study allows to present data collected from multiple methods (i.e., surveys,
interviewers and can provide reliable, comparable qualitative data. Semistructure interviews can provide reliable, comparable qualitative data. Questions can be prepared ahead of time (allows the interviewer to be prepared and appear competent during the interview). It also allows informants
the freedom to express their views in their own terms (Bernard (1988).
Documents review:
Documents comprise a variety of written, visual, and physical material.
Documents are by-products of human activity that document their activity over time (Merriam (1998).
Document review will include: syllabus (theory, clinical/lab), assignments,
in their natural setting without their behaviour being influenced by the presence of a researcher. Data usually consist of detailed information about
DATA ANALYSIS
Data collected will be analyzed by using NVivo software. NVivo is a software for qualitative data analysis (QDA)
REFERENCES
Carper, B. A. (1978). Fundamental Patterns of Knowing in Nursing. Advances in Nursing Science, 1(1), 13-23. Ciliska, D. (2005). Educating for evidence-based practice. Journal of professional nursing, 21 (3), 345-350. Clardy, A. (1997). Studying your workforce: Applied research methods and tools for training and development practitioners. Thousand Oaks, CA: Sage. Field, M.J. & Lohr, K.N. (1990). Guidelines for clinical practice: Directions for a new program. Institute of Medicine, National Academy Press, Washington, DC.
Hemsley-Brown, J.( 2004). Facilitating research utilization: A cross-sector review of research evidence. The International Journal of Public Sector Management; 17(6): 534-552.
Higuchi, K.S., et al. (2011). Implementation of Best Practice Guidelines: The Pioneer Best Practice Spotlight Organization, Final Report. International Affairs and Best Practice Guidelines Program, RNAO. NHS Institute for Innovation and Improvement (2010). Sustainability Guide. NHS Institute for Innovation and Improvement. Mann, B.L. (2006). Case study research and online learning: Types, typologies and thesis research. In Bruce L. Mann (Ed.). Selected styles in web-based educational research. Hershey, PA: Information Science Publishing. Mazurek-Melnyk, B. (2011). Integrating Evidence-Based Practice in Your Curriculum. Retrieved from: http://www.aacn.nche.edu/Faculty/FacultyLink/pdf/2Feb11handout.pdf Melnyk, B.M., & Fineout-Overhold, E. (2011). Evidenc-Based Practice in Nursing & Healthcare. A Guide to Best Practice. (2nd ed). Philadelphia: Lippincott William & Wilkins. Merriam, S. B. (1998). Qualitative research and case study applications in education. San Francisco: Jossey-Bass Publisher. Newton, L. (2009). Knowledge Translation and nursing: What are we translating? In conference proceedings of Building Connections for the Scholarship of Practice. Victoria, BC: University of Victoria. Olson, M. (2009). Document Analysis. In Mills, A. J. Durepos, G. & Wiebe, E. (Eds.). The Encyclopedia of Case Study Research. California: Sage Publications. Ploeg, J., Davies, B., Edwards, N., Gifford, W., & Miller, P.E. (2007). Factors Influencing Best-Practice Guideline Implementation: Lessons Learned from Administrators, Nursing Staff, and Project Leaders. Worldviews on Evidence-Based Nursing, 4(4):210-219. Rogers, E.M. (2005). Diffusion of Innovations. 5 th ed. New York: Free Press. Scheirer, M. A. (1994). Designing and using process evaluation. In J. S. Wholey, H. P. Hatry, & K. E. Newcomer (Eds.). Handbook of practical program evaluation. San Francisco: Jossey-Bass. Schoales-Lada, N. (2006). Making the connections: Using health care research in nursing clinical teaching practice. (Unpublished masters thesis). University of Ottawa, Ottawa, ON. Shavelson, R.J., & Lisa Townes, L. (2002). Scientific Research in Education. Washington, DC: National Academy Press. Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Education Research, 13, 87108. Stake, R. E. (1995). The art of case study research. Thousand Oaks, CA: Sage. The Registered Nurses' Association of Ontario (2005). Enrichment Materials Nursing, Chapter 6: Best Practice Guideline Program. Toronto, ON, Canada: Registered Nurses Association of Ontario. The Registered Nurses' Association of Ontario (2011). Nursing Best Practice Guidelines. Retrieved online from RNAO website: