Nurse Practitioner Curriculum Research Articles

Virtual reality to aid in competency-based online nurse practitioner curriculum (VR-NP)

Virtual reality (VR) simulation use in graduate nursing education is a growing innovative trend that can help with competency-based education. The Virtual Reality Simulation to aid in competency-based online nurse practitioner curriculum (VR-NP) pilot innovation and quality improvement project sought to deliver VR simulation as an educational strategy in an online graduate nursing program advanced health assessment course that enrolled sixty-six students. Twenty-nine of the students were provided loaner VR equipment to complete simulated advanced health assessments from their home while the remainder of students completed the same simulations using screen-based technology. For all students, weekly simulations were paired with follow-up debriefing led by faculty using synchronous web conferencing. Students using VR completed a mid-implementation and post-implementation survey, consisting of the System Usability Scale (SUS), Simulation Effectiveness Tool-Modified (SET-M), and open ended questions. Students using screen-based technology, completed similar surveys with only the SET-M and open-ended questions. Necessary adjustments were made to the implementation process based on data received mid-implementation. Overall students were satisfied with the use of VR simulation from a distance and minimal implementation challenges were encountered. Recommendations for integration of VR into other graduate nursing programs are shared.

Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

Telehealth Virtual Simulation Across the Family Nurse Practitioner Curriculum.

The American Association of Colleges of Nursing recognizes telehealth education as an essential aspect of nurse practitioner (NP) education because it increases accessibility to health care. Studies reported in the literature have focused on NP telehealth simulation, but findings for the inclusion of simulation in multiple courses throughout the curriculum are scarce. This pre- and post-survey design study aimed to evaluate family nurse practitioner students' perceptions of knowledge, confidence, and attitudes regarding telehealth before and after engaging in telehealth virtual simulations in six courses. Simulations were rated highly and telehealth knowledge increased in three of the six courses.

Incorporating Considerations for the Obstetric Patient in Acute Care Nurse Practitioner Curriculum.

Brower, Jennifer DNP, APRN, ACNP-BC, CCRN; Luebcke, Caitlin DNP, APRN, AGACNP-BC, AGNP-C, CCRN Author Information

Incorporating a Psychiatric Telehealth Simulation in a Family Nurse Practitioner Curriculum

The prevalence of mental health disorders in primary care is high and challenges related to the COVID pandemic warrant further training of the family nurse practitioner. A telehealth simulation learning experience that included common primary care diagnoses in mental health—general anxiety, depression, and substance use disorder—was incorporated into a non-clinical behavioral health course. Formative evaluation provided by licensed nurse practitioners confirmed the need for improving interviewing techniques, engaging clients, and promoting safety among this population. Students’ confidence during the encounter was measured using the Simulation Effectiveness Tool. Findings suggest a simulation learning experience is an effective resource for training nurse practitioner students to treat mental health disorders.

Ethics: Crisis Standards of Care Simulation.

Ethical dilemmas exist with decision-making regarding resource allocations, such as critical care, ventilators and other critical equipment, and pharmaceuticals during pandemics. Triage artificial intelligence (AI) algorithms based on prognostication tools exist to guide these decisions; however, implicit bias may affect the decision-making process leading to deviation from the algorithm recommendations. Conflict within the ethical domain may be affected as well. A knowledge gap was identified within the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) curriculum regarding ethics in crisis standards of care (CSC) medical decision-making. Incorporating a CSC simulation looked to address this knowledge gap. A simulation-based learning (SBL) experience was designed as a critical access setting where CSC are in place and three diverse, medically complex patients in need of critical care present to the hospital where one critical care bed remains open. Given the complexity of the simulation scenario, a table-top pilot test was selected. Three AG-ACNP fourth-quarter students in their critical care rotation volunteered for the pilot test. Students were provided with the topic, "ethics crisis standards of care" and the article, "A catalogue of tools and variables from crisis and routine care to support decision-making during pandemics" by M. Cardona et al. (2021), to read in advance. Students were provided with the triage AI algorithm (M. Cardona et al., 2021) utilizing prognostication tools to prioritize which patient requires the critical care bed. The expectation was that implicit bias would enter the decision-making process, causing deviation from the triage AI algorithm and moral distress. The debriefing session revealed that students deviated from the triage AI algorithm, experienced implicit bias, moral distress, and utilized clinical judgment and experience to care for all three patients. The pilot test results support that a CSC SBL experience addresses a critical knowledge gap in AG-ACNP education and an SBL experience incorporating ethical decision-making curriculum with standardized patients should be developed and trialed as the next step.

Competency-based curriculum in nurse practitioner education.

Professional nursing standards and guidelines form the foundation for nurse practitioner curriculum. Nurse educators should understand the role these professional standards and guidelines have in the development of curriculum. Recently, nursing education has moved to a competency-based education with the release of the new American Association of Colleges of Nursing Essentials and the National Organization of Nurse Practitioner Faculties Nurse Practitioner Role Core Competencies. Competency-based curriculum allows for a common understanding of the knowledge, skills, and experiences nurse practitioner graduates require for entry to practice. Competency-based education also provides consistent and uniform expectations for novice nurse practitioners on entry to practice. With the change to a competency-based curriculum, nurse educators can review and revise curriculum through refinement of courses, student learning objectives, assignments, and evaluations. Nurse educators have a responsibility to critically analyze student assignments and evaluations to ensure competencies are met multiple times through a variety of methods. In addition, nurse educators have the opportunity to use assignments that meet multiple competencies to modernize student learning. Refinement and revision lead to enhanced student critical thinking and provide opportunities for real-world training to improve student outcomes.

Enhancing Simulation: A Roadmap for Integrating the Electronic Health Record into the Nurse Practitioner Curriculum

The electronic health record (EHR) is an important health information technology (IT) used to support efficient clinical workflows, patient safety, and quality of care. The EHR is an individual's medical chart stored in digital format for complete real-time information to reduce medical errors and improve outcomes. EHR technology is complex, and users may struggle with efficiently navigating the system for data retrieval, documentation, and time management. Academic institutions are positioned to collaborate with EHR vendors to offer training playgrounds in the curriculum that simulate the clinical interface and support readiness to practice in relevant technology-rich clinical environments. A strategically selected educational EHR vendor matched to the platforms used by major health care organizations may influence clinical partnerships and employment opportunities. EHR competency may alleviate some of the onboarding burden for health care institutions and new graduates at a time of role transition. This article provides strategies for leveraging health IT in the academic curriculum to prepare a technology-proficient workforce capable of meeting the needs of diverse individuals, populations, and healthcare systems.

Medications for opioid use disorder: An interactive educational program developed for the nurse practitioner curriculum.

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths.

Innovative Digital Pedagogy: Adaptive Learning Platform Integration in Nurse Practitioner Curriculum

Adaptive learning platforms are designed to augment health care professional and trainee education by providing engaging, learner-centered content. These technologies can foster learning and improve clinical competency in nurse practitioners (NPs) and students. The integration and engagement of an adaptive learning platform across 2 NP student cohorts is described. Use data demonstrated students’ engagement with platform features. Faculty integration measures influenced use. A program evaluation revealed positive learning style alignment and satisfaction. The use of digital innovations in NP curriculum can positively augment traditional pedagogy and allow learners to expand their knowledge.

Nurse practitioner curriculum puzzle: Connecting all of the documents.

Many organizations, foundational documents, and structures guide nurse practitioner (NP) educators. The number can be overwhelming for nurse practitioner faculty and administrators, but awareness and understanding are essential for developing high-quality NP programs. A set of five key questions is a starting place for NP faculty to identify documents that guide their NP program development and curricula. (1) Which states does your program meet state educational requirements for professional licensure or certification? (2) Which accreditor is your program accredited by? (3) Which certification examinations are your students prepared to take? (4) Which educational competencies/standards apply to your program? (5) Which professional or practice organizations might be influential to your program? The development of high-quality NP programs advances the protection of the public and upholds the reputation of the profession. Organizations, components of licensure, accreditation, certification, education, and practice (LACEP), and key documents from national organizations will be reviewed, including how each of these are complementary and different.

Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.

Implementation of an Online Breastfeeding Education Module Among Nurse Practitioner Students

Background:Lactation support for mother–baby dyads significantly impacts breastfeeding initiation and duration (Busch et al., 2014). Implementing breastfeeding-specific curricula for nurse practitioner (NP) students is fundamental for providing evidence-based lactation care (Webber &amp; Serowoky, 2017).Method:This quality improvement project evaluated the efficacy and satisfaction of an online breastfeeding education module implemented into NP courses. Surveys assessed the demographics, knowledge change, and satisfaction with the experience of online breastfeeding education.Results:Participants completed the optional module and two surveys. A 3% increase in knowledge scores was seen in the postintervention survey. Participants provided actionable feedback. Implementing breastfeeding education into the NP curriculum is feasible and desired by the students.Discussion:Population-focused NP core competencies and knowledge of current breastfeeding education in NP programs are obsolete. Innovation to establish breastfeeding education best practices is needed to produce NPs prepared to support the breastfeeding or lactating patient.

Applying the RIME Framework to Level Nurse Practitioner Curriculum Competencies.

Nurse practitioner (NP) faculty assess student acquisition of knowledge through examinations, simulation, and clinical performance. Developing appropriately leveled curriculum, assessments, and clinical expectations that accurately capture student maturation presents a challenge. The Reporter, Interpreter, Manager, Educator (RIME) provided the framework for doctor of nursing practice NP curriculum redesign to enhance student performance and content mastery. Faculty used a gap analysis approach, iteratively leveling specialty content, course competencies, examination questions, simulation cases, and clinical expectations using the building blocks of RIME. Objective scores on student evaluations for clinical courses exceeded the threshold established, including 83% of simulation encounters. Faculty implemented targeted methods to remediate areas of underperformance. Structuring the course competencies and preceptor feedback around RIME made it easier to pinpoint specific deficiencies and target remediation. It also helped guide discussions about the minimum acceptable standard for student performance.

Differences in perceived clinical knowledge uptake among health profession students and licensed clinicians receiving buprenorphine waiver training in Oregon

Background: Addressing the opioid crisis requires an understanding of how to train both health professional students and practicing clinicians on medications for opioid use disorder (mOUD). We designed a robust evaluation instrument to assess the impact of training on perceived clinical knowledge in these different categories of learners. Methods: We enrolled 3rd and 4th year medical, physician assistant (PA), and nurse practitioner (NP) students, as well as practicing PAs, NPs, and physicians to undertake the Drug Addiction Treatment Act (DATA) Waiver Training for mOUD. We designed and implemented a cross-sectional survey to assess perceived change in clinical knowledge as a result of training in opioid use disorder and satisfaction with training. Results: Twenty-one MD/DO and 45 NP/PA students, and 24 practicing MD/DO and 27 NP/PAs completed the survey. Among health professional students (n = 66) and practicing clinicians (n =51), perceived clinical knowledge scores increased significantly (p < 0.001) for all 13 variables. Program evaluation scores for the buprenorphine waiver training were high with no statistical differences between students and practicing clinicians. Overall, the majority of participants indicated they would recommend the training to a colleague (Students’ score = 4.84; practicing clinician scores = 4.53; scale = strongly disagree = 1 to strongly agree = 5). Conclusions: Our novel instrument allowed us to determine that the implementation of buprenorphine waiver trainings for health professional students and practicing clinicians leads to significant increases in perceived knowledge, interest and confidence in diagnosing and treating OUD. Although the buprenorphine waiver can now be obtained without training, many waivered providers still do not prescribe buprenorphine; integrating training into medical, NP, and PA curriculum for students and offering the training to practicing clinicians may increase confidence and uptake of mOUD.

Simulating Treating in Place in Long-Term Care: Interprofessional Team Care Video Case for Nurse Practitioners

As a means of enhancing clinical simulation opportunities for adult-gerontology nurse practitioner students, a series of video simulations were created for use for nurse practitioner education. With funding through the Health Resources and Service Administration (HRSA) Advanced Nursing Education Workforce grant and partnering with nurse practitioner clinical educators from Optum Health Care, a video simulation focused on the concept of treating an older veteran within a long-term care facility rather than transferring to the acute care setting was developed. The case Treating in Place: Nurse Practitioner-Led Team Management of a Long-Term Care Patient Video involved a nurse practitioner collaborating with a physician, a registered nurse, a social worker, and a family member. The interactive simulation video was developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face-to-face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. A faculty handbook that describes the case scenario with the interactive questions and suggested discussion questions is available. The adult-gerontology primary care nurse practitioner competencies addressed for this case are identified in the faculty handbook. These videos have been widely disseminated and are being included in nurse practitioner curriculum across the country. A QR code with access to direct viewing of the video will be included in the presentation.

Educating Nurse Practitioners About Climate Change, Health, and Climate Justice

Climate change poses unprecedented threats to health, leading to higher rates of heat stress; cardiopulmonary illness; food-, water-, and vector-borne diseases; adverse pregnancy outcomes; poor mental health; and premature death. These impacts are inequitably distributed, with vulnerable populations bearing the greatest burdens. Nurse practitioners must be prepared to care for people affected by climate change and to advocate for policies to mitigate its harm. To date, efforts to integrate climate change and health concepts into health professions education are lacking. This article describes one nursing school’s experience incorporating these concepts into nurse practitioner curricula.

Nurse Practitioner Student Perceptions of a Pilot Simulated Gerontologic Telehealth Visit.

Recently published nurse practitioner (NP) education organization recommendations and telehealth equipment acquisition necessitated integration of telehealth simulation into NP curricula at a large, public university. The COVID-19 pandemic and associated rapid uptake of telehealth accelerated the need for evidence-supported research in tele-health simulation in NP education. A formative gerontologic simulation scenario using telehealth robot technology was developed by synthesizing best practice guidelines for simulation and telehealth delivery. The simulated telehealth visit used standardized patients and embedded participants. Primary care NP students' perceptions of simulation effectiveness, situational realism, and telehealth robot usability were evaluated using three quantitative tools. Thirty-three primary care Doctor of Nursing Practice students participated in this gerontologic telehealth simulation. Students found the simulation to be effective and realistic, and found the telehealth robot technology to be usable. NP students positively evaluated this telehealth simulation experience. Additional research is needed on evidence-based teaching strategies to guide faculty in teaching and evaluating telehealth content. [J Nurs Educ. 2021;60(7):408-413.].

Nutrition Education in Primary Care Adult and Family Nurse Practitioner Programs.

Educating and training clinicians to deliver nutrition interventions is critical to improve population health. However, the adequacy of nutrition education within primary care adult and family nurse practitioner (ANP/FNP) curricula has not been addressed. The purpose of this study was to describe faculty perceptions of nutrition education in ANP/FNP programs. We used a cross-sectional design to gather data on nutrition education. The survey was administered to a convenience sample of faculty from the United States. Our response rate was 47.8% (N = 49). The mean ± SD hours of nutrition education was 14.4 ± 14.6. One-fourth of schools reported that their students received at least 25 hours of nutrition education. Most participants thought it was very or extremely important (75.6%) that their students become more educated about nutrition. There is a need and desire for more nutrition education within nursing graduate curricula. Novel strategies to implement nutrition education in nurse practitioner curriculum are needed.

Well-being Content in Nurse Practitioner Curricula: Facilitators and Barriers

The challenges and stressors of primary care require nurse practitioners to balance patient demands with their own health and well-being. Academic institutions have a responsibility to promote health and well-being among all students, with the goal of their continuing these activities after graduation. Results of this project describe the current state of well-being content integration in the curriculum of a hybrid family nurse practitioner program and identify potential barriers and facilitators of curriculum refinement. Findings provide direction regarding the next steps required to implement well-being content into didactic and workplace learning environments of primary care programs.