![[ Visit Client Website ]](images/banner.gif)
Curriculum Innovation: The Johns Hopkins University School of Nursing developed The Fuld Fellows Leadership Program, a curriculum to provide selected nursing students with a solid foundation in the science of patient safety, quality improvement (QI) and leadership skills. The Fuld Fellows Leadership Program consists of four courses threaded throughout the Baccalaureate curriculum, a 3-day interprofessional intercession course, and a 6-month, service-learning project. The first semester course applies a systems approach introducing students (Fuld Fellows) to the science of patient safety and QI. Using case studies, case-based quizzes and peer assessments, the course prepares fellows with basic knowledge and skills necessary for their work with a clinical project team. Fellows work 50-hours per semester during semesters two and three with a mentor and interdisciplinary, patient safety or QI team in a Johns Hopkins clinical setting. In addition, they participate in bi-weekly, online reflective learning journals focusing on specific attributes of safe, high reliability healthcare delivery teams. In the fourth and final semester, fellows create a scholarly poster presentation and disseminate their project-based learning. Fuld Fellows have an opportunity to participate in a 3-day interprofessional patient safety simulation course that includes nursing and medical students taught by interprofessional faculty. This course focuses on improving students’ teamwork and communication skills and system-based thinking and addresses the causes of preventable harm and evidence-based strategies for harm prevention. Cohorts I-III (n=56) have completed the program as of August 2014 and cohorts IV-VI (n=59) are ongoing.
Evaluation Methods: Process evaluation includes specific questions about course content, delivery, and attainment of learning goals for each course and at end of program, as well as project mentor / mentee evaluation of one another. Pre-post program evaluation includes fellows’ perceptions of patient safety competence at entry into practice, using the Health Professional Education in Patient Safety Survey (H-PEPSS), and systems thinking, using the Systems Thinking Scale. Pre- and post- program scores for the H-PEPSS subscales and Systems Thinking Scale were compared using the Wilcoxon Signed-Rank Test.
Results (From Cohorts I-III): The fellows reported that the mentor-mentee relationship was successful (96%), and they generally demonstrated problem-solving skills (99%), accountability (100%), and professional development (93%). The students found the service-learning portion of the course to have provided a valuable experience (95%) and was intellectually stimulating (91%). Overall, the mentors (n=54) reported that the experience was satisfying (90%), time commitment reasonable (86%), and that they generally were successful in actively involving students in their project (91%). Moreover, mentors identified that student involvement enriched their project teams immensely. Fellows provided the following feedback in end of programs focus groups: “The best part of the Fuld Leadership Program was interprofessional collaboration. The integration with medical students was very helpful and having the opportunity to work on a different aspect of nursing which other students may not have had. I enjoyed the research component which provided an extra push to get a foot in the door with research.” “The program was beneficial towards shaping me as a marketable future nurse. I do believe I will be more aware of quality improvement and safety issues than my co-workers and this will make me a leader in the workforce.” Mean+SD scores on the H-PEPSS scales improved from baseline to end of program as follows: teamwork (3.4+0.6 to 4.5+0.5), communication (3.1±0.6 to 4.7±0.4), managing risk (2.7±0.7) to 4.5±0.5), human environment (3.5±0.9 to 4.7±1.1), recognize and respond (3.2±0.8 to 4.6±0.5), and culture (3.5±0.6 to 4.9±0.3) (p<0.0001 for all). Mean+SD scores on the systems thinking scale increased from 64.3±6.6 at baseline to 70.4±6.2 (p=0.0012).
Conclusion: This innovative program is effective in facilitating learning and application of the patient safety champion role among pre-licensure nursing students. Fellows’ patient safety competence and systems thinking increased to high levels (or improved) after participation in the program, leaving them well-equipped as future leaders of patient safety and QI initiatives. This program can serve as a model for integrating quality and safety concepts into nursing curriculum.