Celebrating 25 Years of Doctoral Education

Alumni came from far and wide to join current students, faculty, and staff for two days of events marking the 25th Anniversary of the doctoral program at the School of Nursing.

Commemorating the Past, Present, and Future of Doctoral Education

On the first night, guests gathered in the new addition of Carrington Hall to enjoy horsdoeuvre and reconnect with PhD alums. Remarks were given by Dean and Alumni Distinguished Professor Kristen M. Swanson about the evolution of the PhD degree at the SON as well as the recent launch of Doctor of Nursing Practice (DNP) degree program. Drs. Debra Barksdale, Director of the DNP program, and Suzanne Thoyre, spoke about the solid foundation doctoral education has at the SON. Students xxx, xxx, and DNP student spoke about the bright future of the programs and how they feel empowered by the education they are receiving at the SON.

Some familiar faces in the crowd included AAN Living Legend Margaret Miles, UNC Hospital Nursing Director Mary Tonges,…

Following remarks, Drs. Barksdale and Thoyre took up a pair of antique silver shears. Following Dean Swanson’s decree, they cut a ribbon draped across the entrance to the new doctoral suite. Officially open for business, guests were invited inside the suite to examine the office space and enjoy desserts.

Calling Forth The Courage

The next day marked the beginning of Calling Forth the Courage: Making a Difference in Health and Health Care. This daylong symposium brought together leaders in business and health care to share provocative ideas and bold approaches that might address how the nursing community can enhance healthcare quality and move advances in health care forward.

The Keynote speaker for the event was recently appointed Dean Doug Shackelford, PhD, of the UNC Kenan-Flagler business school. In his big-picture talk, Dean Shackelford discussed the intersection between the cultures of academia, business, and politics. How experts communicate, he explained, ultimately impacts what progress is made in terms of translating academic findings into business and policy.

“We [academics] prefer to talk to other people who are just like us,” said Dean Shackelford. “But then we just stay in our silos, and our silos get higher and deeper. Regardless of what we find, if it doesn’t support the models we believe in, then we’ll we’re just continue to do work until we find data that supports what we believe in. Because the last thing we’re going to do is change our belief structure.”

Bringing together people with contradicting belief structures is difficult and potentially disastrous. To minimize conflict, Dean Shackelford shared some strategies that he implements at meetings to keep experts on the same page. For example, at meetings of tax experts, Dean Shackelford bans the use of “code sections”, shorthand terms that refer to specific tax laws “Language can become a weapon,” he said. The code sections were jargon used by people who practice tax law, but not by everyone in the room. “We made this rule that you must use simple language; because language is a big deal.”

Setting certain expectations, said Shackelford, also can encourage people to loosen their grip on their belief structures and encourage them to learn from others. “I almost always start our conferences by saying that if you feel comfortable about everything that’s on today’s agenda, you’re probably in the wrong place. We’re not that smart. If you feel like you know half the papers we’re going to cover or that you know about half the people in the room, then you’re probably in the right place.”

Following the keynote, Dr. Chris Tanner, PhD, FAAN, RN, from Oregon Health and Science University turned the focus of the symposium to nursing education. The current model of nursing education, which Dr. Tanner said had its origins at Yale University, has switched the focus of nursing from providing functional support in a hospital setting to total patient care in a variety of settings. Nursing curriculums, said Dr. Tanner, need to be adjusted to keep pace with changes in the modern healthcare system.

One change Dr. Tanner noted was the reduced length of hospital stays and the increase in home care. “Over half of nurses are now practicing outside of acute care settings because of these changes,” said Dr. Tanner “I think it’s time to see a preeminent role for nursing emerge out of this care because it’s clear that preventing rehospitalizations rests with nursing and nurses’ ability to teach patients and their families valuable self-care. There are some great opportunities here for nursing, but we need to have a workforce ready to assume some of these responsibilities.”

The tendency, said Dr. Tanner, is to just add more information to the curriculum. “The amount of content we attempt to cover is ridiculous,” she said. That was a sentiment she carried throughout the streamlining of Oregon’s nursing curriculum in the Oregon Consortium for Nursing Education. “It became clear that we couldn’t add more [content],” she said. “We had to identify what was important. We had to teach for deep learning of the discipline’s most important concepts.”

“We continue to have a need for scholars in health professional education,” said Dr. Tanner at the end of her talk. Without them, she said, it will be difficult to develop nursing curriculums that have the flexibility to adapt quickly to the swift changes in health care.

Fewer organizations adapt to advances in medicine better than the military. At the same time, military organizations are facing problems that are similar to those faced by civilian health organizations. Ethic Minority Visiting Scholar Lieutenant Colonel Angelo Moore, PhD ’10, used his time behind the podium to discuss how military culture influences military medicine.

“All of us [in the military] have healthcare,” LTC Moore said. “So healthcare utilization is an issue.”

In study LTC Moore is working on, he discovered that the average number of health appointments soldiers are receiving every year is 12. “That’s a lot of appointments,” he said. “Some of those numbers are high because as soldiers we have to always be ready. We cannot call in sick. When we’re sick, we have to be seen so that a provider can tell us we need one or two days to recuperate. The system forces us to be seen and that’s part of the problem.”

According to LTC Moore, the focus of military medicine has switched to preventative and primary care. One model the military has begun implementing is the “soldier-center medical home”; a single location in which soldiers can receive care from a variety of providers rather than be referred providers who are further away. The homes are also designed to be placed as close as possible to soldiers’ work locations to minimize travel time. This arrangement, said LTC Moore, always soldiers to receive comprehensive care while they continue to work.

For army nurses specifically, Angelo discussed the Army centers for nursing science and clinical inquiry. Each care region in the army has a center with three PhD-prepared scientists and one clinical nurse specialist who collect data and work towards implementing evidence at the bedside. Their research has led to changes that have made military medicine more patient-oriented. LTC Moore and his colleagues have also contributed to efforts such as the Performance Triad, an effort to encourage soldiers to eat well, exercise, and get a good amount of sleep.

LTC Moore ended his talk by sharing some things the nursing community could do to better support the military. “We all have to work together to provide care for the military population,” he said. “So how can we help serve them?” He said that educators could provide a clear path for individuals who are leaving active duty and want to use their benefits to achieve an advanced degree. Former soldiers with medical training will also be looking for jobs. LTC Moore also advocated more research collaborations between nurses and the military.

Dr. Amy Barton, PhD, RN, FAAN, from University of Colorado has led many collaborations between the University and community partners. One of her best-known efforts is Sheridan Health services, a nurse-managed clinic serving low-income residents of Sheridan, Colorado. Her talk focused on collaboration. “To get it [practice] right is really going to take working together,” she said. “So I investigated frameworks we can use to talk about collaboration and how we can come together in new and different ways.”

She discussed the five different parts of the “collaboration continuum”: contact, cooperation, coordination, collaboration, and convergence. Most health care efforts, said Dr. Barton, tend to wind up between coordination and collaboration. “The challenge for these types of collaborations in health care is that institutional benefits are less tangible because the whole goal is to lift up everybody,” said Dr. Barton.”To make an impact on the future of healthcare, we really need to move towards convergence.”

Another way to envision healthcare systems, said Dr. Barton, is to view it as a continuum of learners. Health professionals must continue to learn best practices throughout their careers. Similarly, patients need to learn self-care from their providers. Clinical agencies, said Dr. Barton, should figure out how to best serve the level of learning that they all need. “Any business is going to structure around the needs of the customer,” said Dr. Barton. “But healthcare hasn’t done that at all.”

The final talk of the day came from Dr. Loretta Sweet-Jemmott, PhD, FAAN, RN. Dr. Jemmott drew from her expertise in the field of HIV/AIDs prevention to discuss ways researchers can partner with communities to make a meaningful difference in healthcare.

“We got to talk about population based health. What got to talk about enhancing the health of people in the communities where they live, eat, work, and play. How do we do this? How do we prepare our students to do this type of clinical practice or to do this kind of research?”

“How do we examine the translation of these models? Or the uptake, the integration, and the sustainability of these models in clinical policy and practice?”

-Give a voice to the people and power to the people. The community research framework must give a voice to the voiceless.

“Researchers work with the community not for the community, and that requires partnership development.

-Focus on implementation science–the study of methods use to integrate new programs or policies into the community.

“This approach takes time and trust, teamwork and transperancy. It requires reflection, persistence, great communication, and above all, commitment.”

“It seeks to understand the behavior of professionals and others [researchers] as a key variable in these studies to see how they uptake, adopt, and promote these programs, and it addresses the level to which they can fit these interventions and programs into real world settings. There are lots of studies that we think are good and effective, but if they can’t be implemented, what the heck did we do them for?”

“If you want to change the behavior of a given population, you must take time to understand why they do what they do.

-Shared her ten commandments of