Advanced practice nursing (APN)

Transcription

1 Nurse Educator Nurse Educator Vol. 34, No. 2, pp Copyright! 2009 Wolters Kluwer Health Lippincott Williams & Wilkins Broadening Horizons Engaging Advanced Practice Nursing Students in Faculty Research Josie A. Weiss, PhD, RN, FNP-BC Inviting advanced practice nursing students to participate in faculty research can be an innovative way to interest students in using current evidence as the basis for their practice. The author discusses strategies for effectively engaging graduate nursing students into research projects in ways that broaden the students perspectives and strengthen their healthcare decision-making skills. Author Affiliation: Associate Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton. Corresponding Author: Christine E. Lynn College of Nursing, Florida Atlantic University, Treasure Coast Campus, 500 NW California Ave, Port St Lucie, FL Advanced practice nursing (APN) students have to acquire a great deal of knowledge and clinical expertise during their educational programs. With so much to learn in such limited time, many students and some faculty members might consider the development of research skills a low priority. Because of increased appreciation for evidence-based practice, finding ways to interest APN students in research and research utilization is more important than ever. Also, because graduate nursing faculty conduct research as well as teach and often practice, student participation in faculty research can be a way to assist both students and faculty. Most APN students value their clinical experiences far more than the development of their research skills. With increased demand for clinical expertise and refinement of APN roles, although important, student involvement in research projects is limited. Blenkinsop argued that involving graduate students in actual research projects can provide deep learning 1(p87) that provides, in experiential ways, foundations for lifelong learning. Knowing how to effectively involve students in research activities is challenging. Rash 2 described a service learning research methods course in which nursing honor students designed research proposals in conjunction with community partners. While this course engaged students, faculty, and community members into the development of research proposals, no studies were initiated. Although schooling methods may differ, the purpose of research courses in Finland is similar to that in the United States: to help students recognize areas of nursing research, to base their actions on research knowledge, and to acquire skills to be able to participate in research. 3 As with students in Finland, the acquisition of this new skill set often seems overwhelming and of questionable value to US students. Mattila and colleagues 3 found that incorporating research instruction through a thesis for a bachelor s degree was an effective way to assist their nursing students to develop research skills and interest. While a helpful learning tool for developing research skills, a thesis is seldom required of US nursing students below the doctoral level. In a rehabilitation counselor education program, Miller and Rintelmann 4 proposed a research practicum as an alternative to a research thesis for graduate students. The purpose of the practicum was to prepare students to become more intelligent consumers and producers of research in the future. The project was also planned to counter negative attitudes held by rehabilitation counseling students toward research utilization, the acquisition of research skills, and the conduct of research after graduation. During the practicum, students worked as research assistants (RAs) for a faculty member or a doctoral student completing a dissertation. Although students were responsible for understanding the full scope of the projects, they were only required to participate in one or more actual components of the research. 4 The practicum provided a beneficial hands-on educational experience that was much less costly in terms of student and faculty time and effort. 4 Similar research practica in nursing programs could be beneficial to APN students, doctoral students, faculty, and, ultimately, consumers. Some APN programs include courses that emphasize research utilization but not the development of research proposals or actual research participation. Quinn 5 described the development of a research utilization course as a means to increase APN student competency in synthesizing research literature, developing evidence-based practiceguidelines, and identifying strategies to use the guidelines. The course was helpful in encouraging students to explore areas for change in their clinical settings, and the hope was that students would continue to seek and use research evidence as their basis for practice in the future. 5 However, the author did not report any follow-up on the effectiveness of the program. Teaching students about research by inviting their participation provides a unique opportunity for APNs to learn, first-hand, about gathering research evidence to guide practice. Inviting student participation could also benefit faculty, whose time involved in teaching often seems to overshadow the time needed for academic research. 1 Integrating teaching, research, and practice, Nurse Educator Volume 34 & Number 2 & March/April

2 as often required of APN faculty, is a highly complex and difficult task. 6 Some researchers have used and mentored nursing students as RAs to support their own faculty roles. 6-8 McGuire 9 found a way to involve social work students, which was beneficial not only for the student-researchers but also for the agency seeking the evaluation and the research participants. Ravert et al 7 developed a facultymentored experience as a means of incorporating not only student learning but also participation in nursing research. The purpose of inviting the students to be RAs was to develop their research skills by involving students in the research process through participation in an actual research project with a human patient simulator. Three RAs participated in developing and implementing simulator scenarios, collecting and analyzing data, and disseminating research findings. In this funded project, students were invited to participate and those students chosen were hired to work 5 to 6 hours per week. The project was not only helpful in increasing students knowledge of and interest in research but also helpful for the faculty member to complete her funded research. 7 Thompson et al 8 incorporated nursing students in a collaborative project between a healthcare facility and an academic center to help meet the needs of both institutions as well as those of the students. During a required nursing course, Thompson and colleagues 8 recruited and trained nursing students to participate in an innovative research project. By actively participating in the project, these nursing students developed more positive attitudes toward research, increased their understanding of the research process, and acquired a new appreciation of the rigors of research. The project was beneficial for the student nurse researchers and institutional partners, as well as the nursing faculty teaching the research course. 8 In a research project with nursing students, Fawcett and colleagues 6 considered the nursing research process to be analogous to the nursing practice process. In this project, junior students in their maternity nursing course assisted in collecting data while learning assessment skills. By using existing instruments, students learned how to effectively gather and record data from patients and from medical records. The project helped students gain a new appreciation for research by understanding the similarities between the nursing process and nursing research and also enhanced the faculty research activities. Members of other disciplines also seek innovative ways to increase students research skills and research utilization for practice, as traditional approaches are often ineffective. Magariaga and colleagues developed a collaborative research project of learning by doing 10(p77) as a means of developing the research skills of physicians in postgraduate training. This 12-month project was based on the 3 principles of problem-oriented (similar to case-based) learning, collaboration between students and faculty, and tangible culminating projects of value (peer-reviewed publications). The students rated the experience as excellent, and, although frustrated with trying to conduct research while meeting their other educational and clinical responsibilities, all of these students recommended the same approach for future students. Proposed Plan Strategies Equipping APN students with research skills, knowledge, and a commitment to research utilization is an obligation of APN faculty. Because APN curricula are already packed with courses necessary for development of the APN role, if students are to be effectively incorporated into research projects, innovative plans are needed. Developing strategies of benefit to students as well as to APN faculty, who have limited time for research, can be beneficial for both. Some funding agencies also favor proposals that include students in ways that increase students research interest and skills. Suggested strategies to facilitate the involvement of students in research projects are shown in Figure 1. The costs and benefits of implementing these suggested strategies are shown in Figure 2. The Community Project Community projects can provide great opportunities for research, funding, and/or student involvement. Faculty members may avoid community involvement due to time constraints. However, community projects can be untapped sources for creative research of benefit to community members, students, and faculty. Rural communities in the Southeastern United States have higher rates of teen pregnancy than most other parts of the nation. Many of these communities have lower socioeconomic and educational levels than other parts of the country, 11 and teen pregnancy may be a contributing factor. Many concerned community members struggle to find ways to effectively address these high rates of teen pregnancy and often appreciate assistance from those in academic communities. While working in an APN faculty practice with high-risk incarcerated adolescent females, I became aware of the high rates of rural teen pregnancy. As a result, I began to interact with leaders from various community agencies including providers in the community and public health system, school administrators, church leaders, and leaders from local organizations such as Healthy Start to address the rural teen pregnancy problem. Most of these community leaders recognized the rural teen pregnancy problem but did not know how to effectively address it. This concern about teen pregnancy by community leaders and access to potential participants created an environment conducive to nursing research. Opportunities for mentoring within our research environments can be developed similarly to those we developed through our faculty practice. At the beginning of each of my APN courses, I share my concerns about teen pregnancy, my research in this area, and the need for more research and improved practice with at-risk teens. Every semester, I find that several students are interested in decreasing the high rates of teen pregnancy and want to work with this population. Finding ways to incorporate their creative resources into research, although sometimes difficult, can benefit students, faculty, and, most importantly, communities. However, developing trust within potential research environments such as rural communities, particularly enough trust to incorporate university students, takes time, persistence, and patience. An opportunity to incorporate interested students into a potential 76 Volume 34 & Number 2 & March/April 2009 Nurse Educator

3 population is important because teens who have experienced 1 pregnancy are at increased risk for additional pregnancies. In this community s abstinence-only environment, the focus of the project was on building self-esteem as a means of preventing additional pregnancies. The project took place in a rural school district where students from the 5 middle schools and a single high school were invited to participate. The local school board and administrative staff of each school approved and supported the project. A project manager worked closely with school officials to schedule each session and obtain written parental consent for high school or middle school students to participate. Four community educators were invited, each of whom would provide 2 of the monthly presentations to students in each school. This team of educators, the project manager, and administrator of the funding agency developed plans to meet the goals of the project. These educators developed their sessions independently. Each gave pretests and posttests to the participants to determine the effectiveness of the presentations and submitted these to the funding agency for further evaluation. I was the only community educator from the academic or nursing community. Other educators included a psychologist, a health educator, and a former school counselor. Figure 1. Strategies to increase student involvement in research projects. research project was created when I was invited to participate in a community project aimed at decreasing rural teen pregnancy. The local project provided an opportunity to develop strategies for engaging students into a proposed community action research plan that could lay the groundwork for a research proposal to be submitted to a larger funding agency giving funding preference for incorporating students. Including APN students was acceptable to the local agency as well, and an incentive opportunity emerged because the agency provided funding for expenses incurred. The project also provided an opportunity to mentor students in the importance of nursing research, the development of research environments and research proposals, and investigation of evidence-based strategies that they could use in practice. The funded project was planned to provide monthly 1-hour sessions within the local schools for teens who had already had 1 pregnancy. This Student Involvement The community project was funded a month before the beginning of a new academic semester. After helping develop strategies for implementing the community project, I began to look for opportunities to engage APN students in ways that would be meaningful to them. During my introduction to a required APN course addressing the needs of families, I shared my concerns about teen pregnancy and my prior research in that field. When explaining the assignments, I invited any interested students to participate in the community project as an alternative to a traditional written assignment worth 25% of the students grade. Much to my surprise, half of the class (15 students) initially chose this option. One purpose of engaging APN students in the community project was to help them recognize opportunities for nursing research in local communities. Initially, students were given current information about the high rates of rural teen pregnancy, the lower socioeconomic and educational levels in this and other rural communities, and their correlation with the disparity of rural poverty. The APN student participants were given 2 different topics (the role of the media and peer pressure) and asked to investigate their association with risky behaviors, particularly teen pregnancy. The APN students were required to work together to create presentations, based on current research findings, designed to promote selfesteem as a pregnancy prevention strategy. These students were also required to determine how the effectiveness of their presentations could be measured. The APN students were asked to travel to the rural community and interact with school officials and rural middle and high school students to give their presentations and to help them understand some of the challenges of implementing such a project. Nurse Educator Volume 34 & Number 2 & March/April

4 Figure 2. Cost-benefit analysis of implementing proposed strategies. At the completion of the project, the APN students were asked to evaluate the effectiveness of the project and they were invited to participate in the development of a manuscript describing the project. In the future, some of these students as well as others will be invited to participate in the development of a research proposal incorporating APN students in the development and implementation of a more complex weekly intervention to decrease rural teen pregnancy. The course in which the community project was offered was provided in an online format, so most instructions and discussions regarding the project were communicated via online discussion groups. The 12 APN students who participated in this project divided themselves into 3 groups to accommodate their individual schedules and locations. The students gave their first presentations in the rural community early in the semester and their second presentations 8 weeks later. Thus, students had time to evaluate the strengths and weaknesses of their first presentations and incorporate any needed changes into the second. Involvement in the community project provided opportunities for these APN students to experience pertinent research issues in a more tangible manner than often occurs with more traditional instruction. The protection of the rights of the participants through the parental consent process and how this may limit participation were evident. The need for effective strategies to promote and protect community relationships necessary for the conduct of community action research including sensitivity to local mores such as the abstinence-only school board policy was clear as we dealt with means of getting APN student in and out of local schools. The need for developing cultural sensitivity became clear as the APN students prepared handouts using the appropriate reading level to accommodate all participants and worked to avoid stereotypical or judgmental attitudes toward pregnant and/or minority teens. Backed by literature searches to locate research evidence, the first presentation addressed the powerful role of the media in the lives of teens. The purpose of the presentation was to help rural middle and high school students recognize the obvious and subliminal messages in the media that promote risky sexual behaviors. Each APN student group addressed a different media form: visual (movies, television,videos),written(magazines,books), or audio (radio). The APN students used PowerPoint, poster presentations, and audio recordings to effectively capture the attention of the participants in ways that would have been difficult if not impossible for nursing faculty to accomplish. They also shared examples of role models familiar to the participants to initiate discussions. Handouts emphasizing the most important points were also provided. Also backed by current research findings, the second presentation addressed the power of peer pressure in encouraging risky behaviors. The purpose of this presentation was to help the student participants recognize the power of peer pressure, different types of spoken and unspoken pressure they may experience, and the feelings that these pressures engender. Role plays were used to help the participants learn how to say no when pressured. The APN students also used PowerPoint, a video clip, and handouts to strengthen their presentations. Again, the creative strategies of the APN students captured the interest of the participants in ways that nursing faculty would have found difficult to accomplish. Ten APN students took part in the first presentation, a number that proved overpowering for the small groups of middle and high school students who attended in each location. As a result, a smaller number (3) of APN students were chosen by their groups to give the second presentation. The remaining APN students assisted with the literature review, the development of the presentation strategies, and the pretests and posttests. At the midpoint, APN students completed anonymous evaluations and participated in discussions of the strengths and weaknesses of the project. The second half of the project was clarified and strengthened based on this information. The strengths of the project for the APN student participants included increased knowledge about the need for research and more effective interventions to address teen pregnancy and increased experience with community action projects. The APN students also reported difficulties organizing their presentations and meeting in working groups while attending classes over such a broad geographic area. Most of the 78 Volume 34 & Number 2 & March/April 2009 Nurse Educator

5 APN student participants believed that this experience would positively impact their future practice with adolescents. Although we did not include all of the suggested strategies in Figure 1 in this project, significant accomplishments were achieved. This project was a first step in incorporating APN students into an action research plan. Inviting students to participate in the development of the intervention resulted in dynamic evidence-based presentations that exceeded the capabilities of the faculty. To strengthen this project, in the future, greater efforts will be made to engage APN students in the active development of research proposals, creation of stronger interventions, and more sophisticated evaluation procedures. Conclusion This example represents an initial step for engaging APN students in a community project that incorporates many strategies necessary for community action research. According to their evaluations, all of the persons involved derived a benefit from their participation. Based on their pretest and posttest results, the middle and high school students became more aware of the power of the media and their peers in promoting risky behaviors. The APN students benefited from their role in developing a research environment, creating, and evaluating an evidencebased intervention. As these students begin their advanced practice careers, it is hoped that they will be more sensitive to the needs of at-risk adolescents and more willing to tackle community projects from a nursing research perspective. The faculty benefited by implementing a plan for including APN students into a community action project. With national agenda focused on finding better ways to meet the healthcare needs of all people, nurse educators and researchers are challenged to think in new ways, moving forward rather than simply longing for better times. Incorporating APN students into faculty research may provide one means of turning barriers into opportunities. REFERENCES 1. Blenkinsop C. Research: an essential skill of a graduate nurse? Nurse Educ Today. 2003;23: Rash EM. A service learning research methods course. J Nurs Educ. 2005; 44(10): Mattila L, Koivisto V, Haggman-Laitila A. Evaluation of learning outcomes in a research process and the utilization of research knowledge from the viewpoint of nursing students. Nurse Educ Today. 2005;25: Miller SM, Rintelmann K. Research practicum in rehabilitation counselor education: learning research through hands-on experience. Rehab Educ. 2007;21(1): Quinn C. Research utilization: a challenge for nursing graduate education to improve patient care. J Nurs Educ. 2001; 40(4): Fawcett J, Aber C, Weiss M. Teaching, practice, and research: an integrative approach benefiting students and faculty. J Prof Nurs. 2003;19(1): Ravert P, Boyer B, Harmon K, Scoffield H. Learning nursing research through facultymentored projects. Nurse Educator. 2004; 29(4): Thompson CJ, McNeill JA, Sherwood GD, Starck PL. Using collaborative research to facilitate student learning. West J Nurs Res. 2001;23(5): McGuire LE. Using qualitative methods to evaluate a group: does the survival skills for women program increase selfsufficiency? Soc Work With Groups. 2003; 26(4): Magariaga MG, Evans AT, Brobbey W, et al. Learning by doing: developing fellows academic skills through collaborative research. Med Teach. 2006;28(1): US Department of Agriculture, Economic Research Service. Rural children at a glance. Economic Information Bulletin Number 1. Washington DC; March Seeking Nurse Educator for Curriculum and Development Join the elite team of professionals at a growing company that is involved in development of new and exciting products to meet the needs of today s nursing programs. Participate in development of test blueprints and all facets of item development. Design and develop resources for faculty and students. Provide curriculum alignment consultation to educators across the country and assist faculty with incorporating products into their curriculum. Requirements: MS in nursing with minimum of 3 years faculty experience in a PN, ADN, Diploma, or BSN nursing program. Item writing skills with a preference for NCLEX-RN and NCLEX-PN writing experience. Ability to communicate and collaborate effectively with professional team in the development of assessment products. If interested in this position, please send a CV and cover letter to: Assessment Technologies Institute c/o Human Resources 7500 West 160 th St. Stilwell, KS or careers@atitesting.com Assessment Technologies Institute is an Equal Opportunity Employer. NURSING RESEARCH Generating and Assessing Evidence for Nursing Practice, Eighth Edition Denise F. Polit, PhD Cheryl Tatano Beck, DNSc, CNM, FAAN June 2007 Approx. 800 pages 87 Illus., 78 Tables Hardcover 2008 ISBN: Resource Manual to Accompany Nursing Research: ISBN: (Sold Separately) horoughly updated and revised Tto emphasize the link between research and evidence-based practice, this Eighth Edition of a classic textbook presents state-ofthe-art methods for conducting high-quality studies. New chapters offer guidance on developing selfreport scales, conducting systematic reviews, and enhancing the integrity of qualitative studies. Also available, the ancillary Resource Manual includes application exercises, models of comprehensive research critiques, a full NINR grant application, and a must-have Toolkit on a CD- ROM, containing a treasure-trove of exemplary research tools-all in easily-adapted Word documents to meet individual research needs. A watershed edition! Visit lww.com to order your copy today! Nurse Educator Volume 34 & Number 2 & March/April