An Innovative Approach to Adult Education in a Two-year BScN Program: Creating Partnerships in Learning

Abstract In the program described in this paper, innovation in nursing education is presented as a response to specific tensions between academic and practice environments in the nursing field. As a unique partnership between a university in northern Ontario and three health care delivery organizations in a large urban environment, the Scholar Practitioner Program (SPP) is an accelerated two-year post degree leading to a Bachelor of Science in Nursing. Using narrative inquiry and cognitive apprentice pedagogies, SPP partners developed an experiential program in which students act as inquirers and co-creators as opposed to receivers of knowledge. Students are also immersed in practice settings throughout the program, supported by clinically based faculty, and connected, at all points, by communication and learning technologies. The benefits, challenges, and opportunities associated with this program from inception to the time of writing are presented for the reader\u27s consideration. The purpose of this reflection on the SPP journey as it includes faculty, students, administrators, and other partners is to inspire others interested in advancing nursing education in Canada. _ Résumé Dans le programme décrit dans cet article, une innovation en formation en sciences infirmières est présentée en réponse à des tensions particulières entre les environnements universitaires et de pratique en sciences infirmières. Un partenariat unique entre une université du Nord de l\u27Ontario et trois organisations de prestation de soins de santé dans un important milieu urbain, le Scholar Practitioner Program (SPP) est un programme post-diplôme accéléré d’une durée de deux ans menant à l’obtention d\u27un baccalauréat en sciences infirmières. À l\u27aide du Narrative inquiry et de pédagogies d’apprentissages cognitifs, les partenaires du SPP ont élaboré un programme expérientiel dans le cadre duquel les étudiantes agissent en tant que chercheures et cocréatrices plutôt que réceptrices de savoirs. Les étudiantes sont aussi en immersion dans un milieu de pratique tout au long du programme, sont appuyées par une professeure rattachée au milieu clinique et sont reliées à tous moments aux technologies de communication et d\u27apprentissage. Les avantages, les défis et les possibilités de ce programme, depuis le début jusqu\u27à l\u27étape de la rédaction, sont présentés aux lecteurs afin qu\u27ils puissent les étudier. Cette réflexion sur le cheminement du SPP, qui implique la participation de professeurs, d’étudiantes, d’administrateurs et d\u27autres partenaires, a pour but d\u27inspirer d’autres personnes qui souhaitent faire progresser la formation en sciences infirmières au Canada

Computerized clinical decision support systems for therapeutic drug monitoring and dosing: A decision-maker-researcher partnership systematic review

<p>Abstract</p> <p>Background</p> <p>Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs) may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing.</p> <p>Methods</p> <p>We conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (<it>i.e.</it>, CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.</p> <p>Results</p> <p>Thirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14), insulin (6), theophylline/aminophylline (4), aminoglycosides (3), digoxin (2), lidocaine (1), or as part of a multifaceted approach (3). Cluster randomization was rarely used (18%) and CCDSSs were usually stand-alone systems (76%) primarily used by physicians (85%). Overall, 18 of 30 studies (60%) showed an improvement in the process of care and 4 of 19 (21%) an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range.</p> <p>Conclusions</p> <p>CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing benefit in the largest studies. At present, no firm recommendation for specific systems can be given. More potent CCDSSs need to be developed and should be evaluated by independent researchers using cluster randomization and primarily assess patient outcomes related to drug efficacy and safety.</p

Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

<p>Abstract</p> <p>Background</p> <p>Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs) have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care.</p> <p>Methods</p> <p>We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others), and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs) of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (<it>i.e.</it>, CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.</p> <p>Results</p> <p>Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35) of studies, including 64% (9/14) of medication dosing assistants, 82% (9/11) of management assistants using alerts/reminders, 38% (3/8) of management assistants using guidelines/algorithms, and 67% (2/3) of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15%) reported improvements, all of which were medication dosing assistants.</p> <p>Conclusion</p> <p>The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.</p