Appendices

A. UMass Lowell-D’Youville Organizational Chart for LTC DEU

B. DEU 2012 Timeline of Events and Activities 11-26-12

C. TCDEU Final Poster St. Anselm’s Nursing Education Conference, May 30, 2012

D. LTC DEU Conference Flyer 8-16-12

E. Evaluations by Participants at the LTC DEU Conference

F. MDHE UMass Lowell D’Youville LTC DEU Presentation at MHA, NAHI 9-26-12

G. GSA Poster Presentation, November 17, 2012

UMass Lowell Nursing Department and D’Youville Center for Advance Therapy Transitional Care – Dedicated Education Unit Partnership 2012 Activities and Events Timeline 

April 2012  

• Thursday, April 26 2012, 12:00‐3:00  ‐ MDHE Site Visit at DCAT • Announcement by Dr. Lisa Abdallah to sophomore Nursing Fundamentals students about 

summer CNA opportunity at D’Youville, April 20, 2012 • Announcement coordinated by Lea Dodge to junior level nursing students who may already be 

CNA‐certified about opportunity for CNA employment FT at D’Youville • UMass Lowell SHE Research Day, Dedicated Education Unit in Long‐term Care:  UMass Lowell 

and D’Youville Center for Advanced Therapy Partnership for Transitional Care – Development, Implementation and Evaluation of an Innovative Clinical Education Model, Paper Presentation, April 27, 2012   

May 2012 

• Summer CNA Student recruitment  o Resumes of interested and qualified UML students to be submitted to Cindy Thornton 

and D’Youville HR  o CNA Certification Exam to be taken by end of May – position is FT June, July and August 

• May 11 – Deadline for second round of MDHE funding • Juliette Shellman and graduate students to conduct interviews and focus groups • May 30 – June 1, 2012 – St. Anselm’s Nursing Education Conference in Hyannis MA 

June 2012 

• Three‐month FT post‐grad residency for Stephanie Tremblay begins (delayed awaiting NCLEX‐RN passing) 

• Data analysis of Eldercare Cultural Self‐Efficacy Scale (Shellman, 2006)  

July 2012 

• D’Youville/UMass Lowell Partnership meeting July 18 in preparation for August 16, 2012 conference and status updates on post‐grad residency and summer CNA FT employment and plans for Fall DEU  

• GSA Annual Scientific abstract notification (tentative) 

August 2012 

• Thursday August 16, 2012 – 8:30‐2:00 ‐ Innovation in Clinical Education Conference to held at the UMass Lowell Inn and Conference Center 

• Post‐conference partnership meeting and plans for publication development and submission 

September 2012 

• UMass Lowell Nursing Graduate/NCLEX‐RN starts 3‐month post‐grad residency • September 22, 2012 – Partner meeting, with authorship/publication dissemination plan drafted 

• September 26, 2012 – Presentation at the MDHE, ONL, MHA, Massachusetts Nursing and Allied Health Initiative Advisory Committee Meeting, MHA Board Room, Burlington, MA; UMass Lowell’s Nursing Education Redesign Project 

October 2012 

• October 25, 2012 ‐ Final partnership meeting with D’Youville Administration, Clinical Teachers, UMass Lowell project staff/investigators  

November 2012 

• November 14‐18/2012 – GSA Annual Scientific Meeting in San Diego, CA; Poster presentation • November 11, 2013 – Deadline for submission to the Ontario Long‐Term Care Research Day 

Conference for February 2013; abstract for poster presentation entitled, Dedicated Education Unit in Long‐term Care: Evaluation of an Innovative Clinical Education Model 

• November 30, 2012 – Final Project Report due to MDHE 

Dedicated Education Unit in Long-term Care - UMass Lowell & D’Youville Center for Advanced Therapy Partnership Development, Implementation and Evaluation of an Innovative Clinical Education Model

Abdallah, L., Dodge, L., Dowling, J.S., Remington, R., Shellman, J. & Melillo, K.D.University of Massachusetts Lowell, Department of Nursing

Evaluation Methods Conclusions

University-Community Partnership Model

Purpose

Acknowledgements

• TCDEU students gained confidence in caring for older adults

• Students reported high satisfaction with the clinical experience

• Students rated themselves as less confident with skills related to death and dying and end-of-life care

• Reminiscence assisted students with communication and connections

To improve the education of nursing students, nursing staff, and faculty in gerontological nursing and highlight nursing care for older adults transitioning from acute care settings as a practice opportunity through the development, implementation and evaluation of a Transitional Care Dedicated Education Unit (TCDEU).

Accomplishments. “This was the best clinical experience I could have asked for. Having had this opportunity was amazing!”Making Connections. “A patient told my co-RN that she wanted me to take care of her while I was there because I took the time to get to know her and that meant a lot to me.”“The most meaningful part of this TCDEU program was the one-on- one experience with the RN.”“He grabbed my hand and told me I was going to be a great nurse and thanked me for all I did for him. This was the most rewarding feeling I have ever felt in my career as a nursing student.”

Gaining Confidence & Skill. “The rotation really helped my nursing skills, critical thinking, and understanding of being a work-ready nurse once I graduate.”“This experience allowed me to prioritize care for 10+ patients.”

Communication. “I found that older adults find therapy in talking about the good and bad times in their lives.”“I found her spirits were lifted when she began telling me stories.”“Reminiscing with older adults brought on feelings of excitement for both myself and the patient. It is a great activity to get to know your patients.”

• Method: Mixed method approach• Data Collection: Focus groups, journals,

interviews pre/post surveys, • Sample: Bachelor of Science nursing students,

(experimental n = 12, control n = 95)• Data Analysis: SPSS 20 & Immersion/

Crystallization by Borkan (1999)

• D’Youville Senior Care Center, Lowell, MA Staff and Administration

• Thank you to our student participants for their time and sharing of experiences

• Funded by Massachusetts Department of Higher Education, Nursing Education Redesign Grant, 2011-2012

Emergent Themes (N=6)

• Sustainable & replicable partnership model integrating long-term care (LTC) into nursing education

• Promotes LTC as a primary career option for nursing students

• Expand to other long-term care sites to increase student-learning experiences using the dedicated TCDEU partnership model

• Conduct Innovation in ClinicalEducation: Dedicated Education Unit Model in Long Term CareConference, Thurs. August 16, 2012

Confidence in Caring for Older Adults (N= )

Implications

• Student Internships- Sophomore internship 10h/wk for 2 semesters- Junior Summer Internship 40hr/wk for 12 weeks- Senior Spring Preceptorship followed by 3

month Summer Residency

Opportunities and Challenges

• Expansion to other D’Youville units and LTC sites • Recruitment of qualified individuals as clinical

teachers (in close partnership w/DON)• Identifying credentialed preceptors in LTC• Determining who would be the credentialed

‘preceptor’ to provide oversight to clinical teachers/staff nurses

• Meeting times to assure continuity of academic-practice partnership goals

• Introduced each others' philosophy and mission• Developed training curricula & handbook• Designated onsite University faculty member • Recruited clinical teachers from D’Youville TCU• Conducted joint training sessions • Implemented two 7-week gerontological rotations• Weekly meetings with clinical teachers• Monthly meetings with agency administrators• Evaluated program feasibility and satisfaction for

students, faculty, clinical teachers• Evaluated changes in student and clinical

teachers eldercare self-efficacy

The Eldercare Self-Efficacy Scale (Shellman, 2006)

28 item, 4 factor scale, ⍺ scores .85-.92Item Response Examples

1 Very little confidence 5 quite a lot of confidence

Item Pre-test Post-testAssess for memory loss 3.0 (SD=.69) 3.3 (SD=.52) Assess medication practices 3.2 (SD=.57) 3.3 (SD=.43)Talk about death and dying 2.8 (SD-=44) 2.8 (SD=.52)Determine social supports 3.0 (SD=.87) 3.9 (SD=.90)Assess for depression 4.0 (SD=.55) 3.2 (SD=.65)Overall confidence 3.1(SD=.53) 3.4 (SD=3.4)

Innovation in Clinical Education: Dedicated Education Unit Model

in Long Term Care

Thursday, August 16, 2012 – 8:30 AM to 2:00 PMUMass Lowell Inn and Conference Center

Lunch with Focused Table Discussions

50 Warren Street, Lowell, MA 01852 Inn accessible via Route 495, 3, and the Lowell ConnectorContact: Stephanie R. Lane @ 978-934-4776 or Stephanie_Lane@uml.edu

Conference Fee: $43 (Includes conference and meals)REGISTER ON-LINE FOR THE CONFERENCE

Nursing at the University of Massachusetts Lowell and D’Youville Life and Wellness Community Presents

Keynote Speaker: Chad O’Lynn, PhD, RN, University of Portland, OR

Partially funded by the Massachusetts Department of Higher Education Nursing Education Redesign Grants, Nursing and Allied Health Initiative 2011-12

Topics include:• Development/Implementation of

Transitional Care DEU in LTC• Clinical Teacher Training• Student and Teacher Outcomes

University of Massachusetts Lowell School of Health and Environment

Department of Nursing

Innovation in Clinical Education: Dedicated Educational Model (DEU) in Long-Term Care

Please evaluate the workshop objectives and presentation on a scale from 1 (strongly disagree) to 5 (strongly agree). Also, please add your comments and suggestions on the back side. Your feedback is very valuable and provides information for improving future workshops

45 Respondents

I. It Takes a Village: Examination of the Implementation of the Long Term Care Dedicated Education Unit Keynote Speaker: Chad O’Lynn

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 13% 87% Objective 1. Identify the need for improved clinical experiences in geriatric and chronic illness learning.

18% 82%

Objective 2. Contrast the DEU model for clinical education with traditional clinical education models.

4% 16% 80%

Objective 3. Explain how the DEU model improves the quality of learning in the clinical setting.

2% 16% 82%

Objective 4. Describe how the DEU model has been adjusted to fit the structures of long-term care settings.

2% 16% 82%

Extent to which personal objectives were met 2% 16% 82% Speakers’ effectiveness, preparedness and knowledge 7% 93% Effective use of teaching methodologies/audiovisual materials. 2% 7% 16% 75% Comments:

• Use the monitor rather than reading from the slide screen so you do not turn your back and have face from microphone

II. Developing Partnerships Karen Devereaux Melillo and Andrea Rathbone

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 18% 82% Objective 1. Identify key factors associated with successful planning and implementation of University and LTC partnership.

25% 75%

Objective 2. Provide details of lessons learned that can be replicated in other academic-practice partnerships considering LTC DEU.

2% 22% 76%

Extent to which personal objectives were met 4% 22% 74% Speakers’ effectiveness, preparedness and knowledge 4% 22% 74% Effective use of teaching methodologies/audiovisual materials. 3% 21% 76%

III. Clinical Teachers’ Experience Lea Dodge, Kerry Foley and Edith Bayiga

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 7% 93% Objective 1. Discuss the role and responsibilities a clinical teacher in the TCDEU.

13% 87%

Objective 2. Identify advantages and areas for improvement in the clinical teacher role in the TCDEU.

11% 89%

Extent to which personal objectives were met 11% 89% Speakers’ effectiveness, preparedness and knowledge 11% 89% Effective use of teaching methodologies/audiovisual materials. 11% 89% Comments

• Use microphone for clinical teachers • Excellent – Loved to hear their perspectives

IV. Student Perspectives Lea Dodge, Shama Billimoria, Kristiana Demers, and Sara Pietila

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 7% 93% Objective 1. Provide a description of the typical day of a nursing student assigned to the TCDEU.

7% 93%

Objective 2. Discuss advantages and areas for improvement for the TCDEU from a student perspective.

9% 91%

Extent to which personal objectives were met 7% 93% Speakers’ effectiveness, preparedness and knowledge 2% 4% 94% Effective use of teaching methodologies/audiovisual materials. 7% 93% Comments:

• They just read about their experiences – it seemed rehearsed • Slides did not match students presentations in an organized manner • Excellent • Excellent • They did a spectacular job • Better microphone placement • Great

V. Outcomes, Opportunities and Challenges Juliette Shellman, Cindy Thornton and Lea Dodge

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 18% 82% Objective 1. Describe student, faculty, and staff perceptions of the TCDEU experience.

20% 80%

Objective 2. Discuss the effects of participating in the TCDEU experience on nursing students' eldercare cultural self-efficacy.

2% 11% 87%

Objective 3. Identify the challenges encountered in the development and implementation of the TCDEU.

20% 80%

Objective 4. Discuss strategies to address the identified challenges.

2% 7% 18% 73%

Extent to which personal objectives were met 2% 4% 22% 71% Speakers’ effectiveness, preparedness and knowledge 2% 2% 20% 76% Effective use of teaching methodologies/audiovisual materials. 4% 7% 13% 76% Comments:

• Fair • One needed to use microphone • Excellent, brief, to the point • Reading quotes was not very helpful

VI. Debriefing and Evaluation Lisa Abdallah

Strongly Disagree

Disagree Neutral Agree Strongly Agree

Relevance of content to workshop and objectives 11% 89% Extent to which personal objectives were met 18% 71% Speakers’ effectiveness, preparedness and knowledge 13% 87% Effective use of teaching methodologies/audiovisual materials. 2% 16% 78% Comments:

• Very well done

VII. Conference Venue Strongly Disagree

Disagree Neutral Agree Strongly Agree

Quality of Breakfast 6% 16% 78% Quality of Lunch 2% 7% 91% Convenience of Location 2% 9% 13% 76% Appropriateness of site for learning 18% 82% Overall workshop 9% 91% General comments or suggested topics for future workshops:

• Summer is a good time, less traffic • Excellent conference and program, provided a lot of food for thought • Hope to see more LTC DEUs in the future • Excellent program, innovative and interesting • Well done! • Has made me so excited about this initiative! • I wish graduate student would have been allowed to speak instead of just standing there • Excellent environment, food and facilities • Great food and support personnel • Too Cold! • Excellent site and food! • Room was too cold • Excellent program, I really enjoyed! It is very much needed • Great conference! Would love more contrast to traditional model and more information about sparking

partnerships. Loved the different perspectives • Excellent program – good speaker representation. Real “take away information” • Excellent conference – demonstrated in the energy of the audience discussion and dialogue • Great Program – Well organized and clear delivery of content. The students were excellent and the best judge of

the program • Enjoyed the partnership in the presenters. Students did a wonderful job • Nice Job – Thank You • Excellent workshop, Loved the student and staff presentations, Faculty very enthusiastic. A little cold in the room

otherwise nice venue • Provide a participant list to all attendees in their folders • Inspiring! I hope I can replicate this mode in the LTC facility we are using for clinical • More detailed strategies for addressing challenges would have been helpful. Overall this program was very

informative and created energy to move forward with the model • Some of the slides and handouts were very busy and difficult to read especially in Chad’s presentation • Room was quite cold at times – Participants went outside to “warm up” – Last but not least….. Great

presentations: Let’s do this again • Room was uncomfortably cold even after asking staff to turn up temp • Overall review of UMass Lowell project: A few more details would have enhanced understanding: Unclear of the

average age of the patients in the TCU- were they older adults (as this wasn’t a LTC unit)? Keynote speaker was great –informative, enthusiastic and enjoyable

ABSTRACT Nursing education and healthcare institutions

must adapt to meet the needs of adults 55 and older with multiple chronic

illnesses and post-acute care needs as they transition from shorter

hospital stays to home or long term care facilities. Providing innovative,

cost-effective, patient-centered clinical experiences that include

comprehensive education in the care of older adults for nursing students

and staff is imperative. The purpose of this project was to improve

education of nursing students, nursing staff, and faculty in gerontological

nursing. Using a university-community partnership model approach, a

Transitional Care Dedicated Education Unit (TCDEU) was developed.

Partnership activities included development of preceptor training manuals,

conducting joint training sessions for faculty and staff, implementing

student summer internships to foster long-term care as a primary career

option for new BSN graduates, development of clinical placements for

junior nursing students, and hosting a workshop for long-term care

facilities and Massachusetts institutions of higher education to provide

hands-on training materials. A quasi-experimental pre-posttest design was

utilized to determine the effectiveness of the program on BSN students’

eldercare cultural self-efficacy. Contextual data were collected via focus

groups to evaluate program satisfaction and learning outcomes. Data

show increases in students’ confidence in caring for older adults.

Students, clinical teachers and partners report high satisfaction with the

program. Results indicate this TCDEU is an innovative nursing education

model that integrates long-term care into nursing education and promotes

long-term care as a primary career option for nursing students.

Implications for gerontological nursing education & practice will be

discussed.

PROGRAM EVALUATION

Descriptive study

Pre-/post-test design

Focus groups, key informant

interviews, and content analysis of

student reflections.

Dedicated Education Unit in Long-term Care: Evaluation of an Innovative Clinical Education Model

Lisa Abdallah, PhD, RN, CNE, Lea Dodge, MS, RN, Jacqueline Dowling, PhD, RN, CNE, Naomi Prendergast, MPH, LNHA, Andrea Rathbone,

MHSA, LNHA, Ruth Remington, PhD, ANP/GNP-BC, Juliette Shellman, PhD, RN, Cynthia Thornton, BSN, RN, &

Karen Devereaux Melillo, PhD, ANP-C, FAANP, FGSA

University of Massachusetts Lowell and D’Youville Life and Wellness Community, Center for Advanced Therapy, Lowell, MA

This work was supported by the Mass. Department of Higher Education, Nursing and Allied Health Initiative, 2011-2012 Grant

PURPOSE

SETTING

D’Youville Life and Wellness Community,

Lowell, MA

D’Youville Senior Care is a 208-bed traditional

long-term care setting, with dementia special

care, and short-term rehab; JCAHO accredited.

D’Youville Center for Advanced Therapy is a

33-bed state of the art Transitional Care Unit;

JCAHO accredited.

Population served – average age 77;

68% female; 3% ethnicity other than White.

“The team members really helped spark

the energy. The team dynamic was good

and that helped the energy to infiltrate to

the clinical teachers and to the students.”

• Transitional Care DEU students gained

confidence in caring for older adults

• Students reported high satisfaction with the

clinical experience

• Students rated themselves as less confident

with skills associated with death and dying

and end-of-life care

• Reminiscence assisted students with

communication and making connections

What was accomplished?

• DEU in LTC/Transitional Care established,

implemented, evaluated and expanded

What are the key aspects?

• LTC administrators, clinical staff, UMass

Lowell faculty and students highly positive

What is the path forward?

• Expanding on numbers of students

participating in LTC DEU at this site and

developing DEUs in other settings

Nursing education needs to provide

innovative clinical experiences to prepare

students to care for at-risk populations

with multiple chronic conditions and for

those needing ST rehabilitative services.

Improving community-academic

partnerships that address health care

needs and nursing educational

opportunities is imperative.

DEU provides meaningful clinical

experiences for students and promotes

development of nurse faculty, while

delivering high quality care to patients.

SIGNIFICANCE

1. Improve education of nursing students,

nursing staff and faculty in

gerontological nursing

2. Provide innovative cost-effective,

patient-centered clinical experience in

transitional care / LTC settings for

nursing students:

• Develop a preceptor training manual

• Conduct joint training sessions for

faculty and staff

• Implement student summer internships

and post-grad residency to foster LTC

as a primary career option for new BS

graduates

• Develop clinical placements for junior

nursing students

• Host a regional workshop for LTC

facilities and MA institutions of higher

education

RESULTS

Qualitative Analyses – Emergent Themes

Clinical Teacher Perspectives

Collaboration

Motivation to advance education

Partnership Perceptions

Melding of education & practice

Excitement and energy

Communication

Challenges - staffing and scheduling

Identifying roles

Students’ Perceptions

Real life nursing

Making connections

Gaining confidence & skills

Communication

Quantitative AnalysesEldercare Cultural Self-Efficacy Scale (Shellman, 2006)

Confidence in Caring for Diverse Older Adults

Statistically significant increase in overall ECSES scores from Pre-

test (M=3.21,SD=.39) to Post-test (M=3.5, SD=.21), t(11)=2.9,p,.05. eta

squared =.19

Statistically significant increase in caring for White older adults

scores from Pre-test (M=3.6, SD=.57) to Post-test (M=4.02, SD=.29),

t(11)=3.9, p<.05. eta squared = .26

No significant findings in caring for other ethnic groups.

CONCLUSIONS

INTERNSHIPS AND PRECEPTORS

• Sophomore Gerontological

Nursing/LTC Internship

• Summer CNA Paid Internship for

nursing student under RN preceptor

• Senior year, Spring semester

preceptorship

• Post-Grad Residency in LTC x 3

months

EVALUATION OBJECTIVES

1. To determine student, faculty and staff

satisfaction with the Transitional Care

Dedicated Education Unit Initiative

2. To evaluate changes in students’

eldercare cultural self-efficacy post-

participation in the TC DEU clinical

experience

DATA ANALYSIS

Qualitative

Immersion/Crystallization technique

(Borkan,1999)

Quantitative

SPSS 20

Descriptive

T-tests

“This was the best clinical experience I

could have asked for. Having had this

opportunity was amazing!”