The purpose of this study is to assess the effectiveness of a new course curriculum initiative in the undergraduate baccalaurette nursing program. A core component of the initiative includes the concepts of wisdom leadership. Wisdom leadership, in the healthcare setting, is defined as the capacity of health care providers to build deeper connections, to be aware of their own thoughts and biases, and to communicate profound thoughts while appreciating the complexity of human life (Plews-Ogan & Beyt, 2013). There are two types of wisdom: general and personal (Matney, Staggers & Clark, 2016). General wisdom is directed towards others and personal is about one’s own issues and decisions (Matney, Staggers & Clark, 2016). The goal of cultivating wise nurses is to combine the general and personal scopes of wisdom in order to best care for patients, while also taking care of themselves to reduce burnout. To combine both aspects of wisdom requires nurses to have compassion towards others while understanding their own limitations. The nursing community must now strive to teach wisdom leadership to nurses before reaching their full scope of practice. At the University of Virginia, the School of Nursing’s mission has been for over one hundred years now to create compassionate and wise nurses. A significant part of that mission is achieved through the Compassionate Care Initiative. As part of the Compassionate Care Initiative, the Wisdom in Nursing (WIN) program’s purpose is to enhance the School’s curriculum to better prepare nurses to be fluent in general and personal wisdom before job attainment. Stemming from the University of Virginia Medical School’s Phronesis Project, based on the Model of Wisdom development, in which medical students were given opportunities beginning in their first year to foster wisdom through longitudinal patient relationships and seminars focusing on creating therapeutic relationships with patients and self-care (Plews-Ogan & May, 2016). Students in the School of Nursing now have the opportunity to participate in a similar care longitudinal relationship with a patient (care partner) in order to learn how chronic disease manifests in the actual lives of patients over time. The program also strives to include mindful practice in the curriculum in the form of multiple practices that teach skills such as compassion, deep listening, forgiveness and motivational behavior. The hope of the program is that after their time in the WIN program, students will be better equipped to face all of the challenges of the profession and combat burnout compared to the students in the traditional Bachelors’ of Science (BSN) program. The successfulness of the curriculum will be measured through a set of validated questionnaires and compare the scores of the questionnaires for both intervention and control groups to assess the ability of the curriculum to teach wisdom.
Designs and Methods:
Nine second year BSN students were selected through an intense application process to participate in the WIN program. Every third student from the remainder of the second year class roster was invited to participate in the control. From the third of the class invited, the first nine students to respond to the invitation and sign the consent form were chosen to be in the control group. The total of eighteen students participating in the study will complete five different surveys at three time points during the current school year. The five surveys include the Quality of Life Scale (Thomas, Duybye, Huntington, et. al., 2007), Patient Health Questionnaire-4 (PHQ-4) (Kroenke, Spitzer, Williams & Löwe, 2009), Three Dimensional Wisdom Scale (Ardelt, 2003), Mindfulness Attention Awareness Scale (MAAS) (Brown & Ryan, 2003), and the Tolerance for Ambiguity scale (Gellar, Tambor, Chase & Holtzman, 1993). The results of the surveys will be analyzed longitudinally to assess differences between the control and intervention groups.
Anticipated Findings:
If the program is effective in guiding students to cultivate wisdom, the students in the intervention group will produce scores that show greater cognitive, affective and reflexive wisdom. In general scores of the intervention will show improvement in the overall wellbeing of the participants and the control’s scores will not show the same improvement. For the Quality of Life Scale, the possible score ranges from zero to ten with ten representing the highest quality of life (AACM, 2015). WIN program students will over time have higher scores on the Quality of Life Scale. The Three Dimensional Wisdom Scale is divided into three different parts: cognitive, reflective, and affective (Ardelt, 2003). Each item in the three domains is scored on a scale of one to five and each item in the certain domain is averaged for the domain score (Ardelt, 2003). The closer the score is to five demonstrates higher levels of wisdom in each domain (Ardelt, 2003). As the year progresses, the participants in WIN program will have scores closer to five demonstrating higher levels of wisdom. The PHQ-4 scale is a quick screening tool for anxiety and depression. A score higher than two in a certain set of questions indicated a positive screen for anxiety or depression (Kroenke, Spitzer, Williams & Löwe, 2009). As part of the WIN Program, participants will develop appreciative practices to decrease stress and therefore score lower on the PHQ-4 scale. The MAAS is a scale that assesses the ability of an individual to be present or aware of the present moment instead of being distracted by the past or pulled into the future. The final score is the mean of the fifteen items and the scores closer to six demonstrate higher levels of mindfulness (Brown & Ryan, 2003). Participants in the intervention group will after going through the WIN program have scores closer to six. The Tolerance for Ambiguity scale measures one’s ability to cope with uncertainty. Scores range from seven to forty-two and scores closer to forty-two are associated with greater tolerance for ambiguity (AACM, 2015). Students in the WIN program will have greater tolerance for ambiguity compared to the students in the control group. The control group will not have the same improvement due to the lack of additional mindfulness and care partner experiences that the intervention group has.
Clinical Relevance:
The health care setting can be extremely stressful and nurses are not immune to the effects of this stress. In 2011, the American Nursing Association conducted a survey that found that acute and chronic stress is one of two top concerns for workplace safety (Roberts & Grubb, 2013). The acute and chronic stress leads to burn out and compassion fatigue, ultimately leading many nurses to leave the profession (Cocker & Joss, 2016). The loss of humanity that accompanies burnout also affects nurses ability to deliver optimal care. The expansion of the WIN program to every BSN student at the University of Virginia and other nursing institutions will help teach nursing students how to cope with workplace stress, prevent burnout, and deliver optimal compassionate care to their patients.
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