The United States Department of Veterans Affairs (DVA) has long been a champion in developing academic practice partnerships and there is growing evidence that supports the benefits of these collaborations (Beal, 2012; Bvumbwe, 2016). The Veterans Health Administration (VA) Nursing Academic Partnerships (VANAP) are education and practice collaborations between VA facilities and schools of nursing designed to ensure quality veteran care now and in the future. The purpose of this presentation is to describe the evolution, development and benefits of a local VANAP partnership in facilitating clinical practice improvement initiatives and integrating veteran-centric content into a baccalaureate nursing curriculum.
There are approximately 21.4 million living United States veterans, representing seven percent of the total population (U.S. Census Bureau, 2016). The VA serves a unique population of patients linked by service to the country in times of peace, war, and social unrest. In addition to the common medical concerns found in the general population, veterans experience unique conditions that are associated with service in the military, or experience health concerns in greater percentages than seen in the private sector. Some of these conditions include military sexual trauma (MST), traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and complications from exposure to nuclear, biological, and chemical warfare (Johnson, Boudiab, Freundl, Anthony, Gmerek, & Carter, 2013).
Oregon VANAP is an innovative education and practice collaboration between VA facilities and the Oregon Health & Science University (OHSU) School of Nursing (SON) (Department of Veterans Affairs, Veterans Health Administration, 2013). Through the partnership between academic and clinical areas, VANAP seeks to address the complex and unique care needs of the veteran population by promoting safe and effective care within and across health care settings (Department of Veterans Affairs, Veterans Health Administration, 2013). Faculty members in this partnership are drawn from both school of nursing and VA staff who join together as a team to educate nurses and improve clinical outcomes for veterans.
In order to integrate veteran content into the existing nursing curriculum, VANAP faculty members identified and collaborated with key stakeholders in the undergraduate nursing program. Faculty conducted a literature review to identify key veteran care concepts based on prevalence and importance. They then examined the curriculum for areas where veteran content was already being taught and identified gaps where additional material could be added. To engage students using multiple learning modalities they utilized veteran-centric case studies, simulations and concept-based learning activities in addition to traditional methods of assigned readings and lecture. This strategy of content integration exposed students to veteran-specific information while also teaching concepts that could be broadly applied to a variety of populations.
In addition to enhancing nursing school curriculum, VANAP faculty worked with VA staff on three clinical practice improvement projects: fall reduction in the inpatient setting, women veterans’ health, and amputation prevention. Faculty collaborated with direct care nursing staff, nurse leaders, and other interdisciplinary team members to develop and implement plans to address these issues. The faculty utilized a variety of evidence-based interventions to effect change including conducting gap analyses and needs assessments, developing patient and staff education, and conducting focus groups.
VANAP faculty members were successfully able to integrate veteran-centric content into all courses of the undergraduate curriculum. A content integration map was developed outlining specific content and where it was being taught. To share resources with other faculty teaching similar courses, this map was disseminated to other nursing schools in the region via a nursing school consortium.
Some outcomes of the quality improvement initiatives were a decrease in the number of falls and 30-day readmissions related to amputation risk. A preliminary comparison of average fall rates were lowered by 57% per 1,000 patient days on the medical-surgical floors and the percentage of falls with injuries decreased by 62%. Twenty-two fewer readmissions related to vascular complications were realized on an inpatient unit during a six-month review after VANAP faculty interventions as compared to the preceding six months before VANAP involvement. This represented a 47% decrease in vascular related readmissions.
Veterans are a population with unique health care needs. Integrating veteran-centric content into the nursing curriculum and educating students on evidence-based practice promotes the best possible care for veterans and their families. The benefit of such work will result in more culturally competent nurses working in and outside of VA facilities. Faculty were able to play key roles in designing and implementing quality, evidence-based improvement initiatives at the practice institution while maintaining teaching positions at the academic institution. Involving stakeholders early in the process, maintaining frequent communication, integrating collective feedback and establishing meaningful evaluation processes allowed creation of a program that met student, faculty and veteran needs. Future evaluation will include assessing the sustainability of this project as well as its impact on student knowledge and application of veteran content. This exemplar has the potential to serve as a model for others seeking to develop relationships between academic and practice institutions.
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