The current process of prioritization used by nurses is creating unmet needs for patients, especially psychosocial, emotional, and educational needs (Jones et al., 2015).
- Missed nursing care is imposing a negative impact on quality and cost of care to patients (Kalisch, 2006; Kalisch, Landstrom, & Williams, 2009; Papastavrou et al., 2014a; Papastavrou et al., 2014b).
Evidence of interventions to address missed nursing care is essentially nonexistent in the literature (Jones, Hamilton, Murry, 2015). Need interventions to improve missed nursing care, such as:
- Improved communication
- Improved teamwork
- Increased job satisfaction
- Improved staffing
“Although the nursing care environment has changed significantly over the past 30 years, little has changed in the educational models used to prepare nurses.”
Dedicated Education Unit (DEU)
- Collaborative venture between a university and a practice institution that uses existing resources, reframes roles, and allows nursing students to participate fully as members of a patient care unit (Dedicated education unit, N.D.).
- Patient care unit hosts students from a single school of nursing, pairing each student with a staff nurse who will serve as their clinical instructor (Glazer, Erickson, Mylott, Mulready-Shick, & Banister, 2011).
- Academic faculty member transitions to a role of coach and mentor for these expert staff nurses in the health care institution, who may need additional training and resources as educators in evaluating and providing feedback to students.
Current DNP project is a part of a larger research undertaking with involvement of multiple members from both the academic and practice partners acting as co-investigators.
- Institutional Review Board (IRB) approval from Mayo Clinic
- Control group in the fall of 2015--traditional clinical group that staff is accustomed to hosting on the unit.
- A pilot study using the DEU clinical model as the research intervention was initiated in January of 2016
- The pilot study will conclude in May of 2016 at the end of the spring semester for the WSU undergraduate nursing program
Knowledge-based:
- Mayo Clinic interest in DEU clinical model
- Support for DEU model in literature and from multiple national agencies
Problem-focused:
- Risk management to reduce risk to patients
- The threat of missed nursing care
- Financial repercussions of turnover & orientation costs
Impact of the Dedicated Education Unit on Missed Nursing Care
Introduction of the Problem
Tradition of Quality Patient Care
Delivered at Mayo Clinic
- "The needs of the patient come first."
- Preparation of students for careers in health care
- Fulfillment of Magnet Status criteria
Thank you for your willingness to take part in this journey!
Triggers:
Decision Point:
Monitor & Analyze Structure, Process, & Outcome Data
Is this a priority for the organization?
Decision Point:
Is change appropriate for adoption in practice?
Pilot Change in Practice
Form a Team
Current team consists of the Chief Nursing Officer, Nurse Administrator for the Education & Professional Development division, and Program Director Nursing Academic Affairs at Mayo Clinic. The leadership on MB5D/E also play an active role, as well as those persons from the WSU nursing program, which include the Dean of School of Nursing & Health Sciences, Department Chairperson, Program Coordinator, and Clinical Faculty Coordinator.
Decision Point:
Is there sufficient research base?
Iowa Model of Evidence-based Practice to Promote Quality Care
Assemble Relevant Research & Related Literature
Critique & Synthesize Research for use in Practice
“The birth and implementation of the DEUs were in part a response to the shortcomings of traditional clinical teaching models, but also an opportunity to instill a much improved relationship between clinicians and academics” (Edgecombe, Wotton, Gonda, & Mason, 1999, p. 170).
- The mutual accountability of both parties enhances patient safety and quality of care (MacIntyre et al., 2009).
DNP Project Focus:
Population: Inpatient staff on Mary Brigh 5 D/E clinical unit at St. Mary’s Hospital (Mayo Clinic)
Intervention: Implementation of a dedicated education unit (DEU) clinical model
Comparison: A traditional clinical model
Outcomes: Nurse perceptions of quality of care on the patient care unit
Timeline: The project started during the summer of 2015 with searches of evidence and pursuance of approval from the IRB for the pilot study. Control group data gathered fall of 2015. Experimental group data to be gathered spring of 2016. Evaluation, synthesis, & dissemination efforts will continue throughout the summer and fall of 2016.
Missed care occurs during the process of care at the point of nurse to patient interaction, therefore these errors have a direct influence on patient outcomes and the quality of care, without exposure to any dilution processes (Schubert et al., 2007).
The Dedicated Education Unit Clinical Model
The Missed Nursing Care Model serves as the conceptual framework for this DNP project (Kalisch et al., 2011a).
(Niederhauser, MacIntyre, Garner, Teel, & Murray, 2010, p. 353)
Cynthia Jones, MS RN
Winona State University
In collaboration with DEU Project Team Members