In 2018, the Pre-Professional Health Sciences Academy (PPHSA) celebrated its fifth year at Barnes-Jewish West County Hospital.
The PPHSA is a partnership between Barnes-Jewish West County Hospital, BJC School Outreach and Youth Development, Parkway School District and Special School District of St. Louis County. It allows Parkway High School seniors to spend a full year exploring their interest in health-care professions.
So far 90 students have participated in the program. Prior to arriving on the Barnes-Jewish West Hospital campus each January, students spend a semester learning medical terminology, human anatomy and body systems, and infection prevention, in addition to being certified in Basic Life Support (BLS) CPR and practice evaluating vital signs.
In January students start their rotations through 17 Barnes-Jewish West County Hospital departments. Each student spends approximately three hours with a hospital professional learning about each department and their impact on patient care.
In addition to helping students solidify career interests, BJC School Outreach and Youth Development tracks students after high school graduation and through college. As students graduate and earn their licenses, they are directed to representatives from human resources, hopefully connecting back to the BJC family, this time as employees.
“The Parkway Pre-Professional Health Sciences Academy is a wonderful way to expose high school students to the vast array of job opportunities available in health care, and is an important part of building a pipeline to attract future BJC team members,” says Trish Lollo, Barnes-Jewish West County Hospital president.
From January through April 2017, on Tuesdays and Thursdays and alternating Fridays, high school students Alayna Jones and Kamala Nepal spent their class time at Goldfarb School of Nursing at Barnes-Jewish College. As seniors at the Collegiate School of Medicine and Bioscience, a magnet school in St. Louis, they were required to complete either an internship or a capstone research project. Both chose the inaugural Goldfarb internship in nursing research because of their interest in pursuing careers in health care.
An Education in Nursing Michael Ward, PhD, RTR, FASRT, Goldfarb’s vice dean for student affairs and diversity, serves on the advisory board at the Collegiate School. He suggested establishing the nursing research internship to Jean Davis, PhD, RN, FAAN, the Paul J. McKee Jr. senior associate dean for research and doctoral studies. “We felt it fit well with our goal of educating high school students about career opportunities in nursing research,” says Davis. “But the scope of the internship went beyond research. We wanted Alayna and Kamala to really understand the roles and responsibilities nurses play in today’s patient care team.”
For that reason, most Tuesdays were nursing-focused. Jan Holbrook, MSN, RN, CCRN, FBN/FPN, assistant professor at Goldfarb, introduced them to the responsibilities of various nurse specialists such as bedside nurses, nurse practitioners and clinical specialists. She also took the interns to Goldfarb’s Clinical Simulations Institute, a state-of-the-art simulations lab where they not only observed nursing students working with manikins but also participated in patient-care scenarios. Barbara Whitaker, MPH, BSN, RN, a Goldfarb instructor, introduced them to the important work done by community health nurses.
Research — Doing is Learning On Thursdays and some Fridays, the interns learned about nursing research. They spent time with researchers working on wide-ranging studies, from oncology symptom management to effects of HIV on women and aging populations. Davis felt talking with researchers and observing them was not enough, however. “I decided that if they really wanted to learn about nursing research, they should work on a research project of their choosing,” she says. That choice was nutrition.
“My family has a history of high blood pressure and obesity, so I am all about health and healthy eating,” says Jones. “Kamala and I were aware that our classmates ate a lot of snacks, most of them unhealthy. We wanted to see if we could make a difference in changing their eating habits.”
Their methodology consisted of choosing 10 unhealthy snacks that appealed to their peers and 10 healthy alternatives. Seven high school students taste-tested the 20 food items. They then enrolled seven adults as a comparison group. The results: Most teenagers preferred unhealthy food to healthy food, whereas adults preferred healthy food to unhealthy selections.
Jones and Nepal prepared a poster presentation portraying the nutritional label of each food item so teenagers could understand why the healthy foods were better choices. Prior to the presentation, the teenagers were asked to record their consumption of the 20 food items for a week; after the presentation, they again recorded their snack food choices for seven days.
“We coached them along the way, but Alayna and Kamala did all of the work themselves, from analyzing fat calories, salt and sugar on the nutrition labels to scoring and analyzing the data using interrater reliability to determine the accuracy of their findings,” says Davis. Davis felt the quality of the interns’ work deserved reward, which meant serving as presenters at Goldfarb’s annual Graduate Scholarly Project Poster Presentation Day. It was then that Davis saw the internship’s impact on Jones and Nepal.
“When they first started with us, they were obviously bright but shy and quiet. By the time of their presentation, it was evident how much they had grown. They were confident in their findings, and they knew their subject well enough to answer questions quickly and with authority,” says Davis. “They had fun throughout because it was their project, which they managed from start to finish.”
Looking to the future After high school graduation, Nepal will begin taking pre-med courses at Blackburn College in Carlinville, Ill. She initially wanted to become a physician, but her experience at Goldfarb has given her insight into the opportunities available in nursing research. Jones will begin taking nursing prerequisite courses at the University of Missouri – St. Louis and then plans to transfer to Goldfarb.
“This internship forced us to get out of our comfort zone and talk to people and communicate. That is really going to help me as I enter college,” says Jones.
Adds Nepal, “The opportunity to interact with the nursing students made it feel like we already were in college. And having the guidance of Goldfarb’s professors made me realize that there’s no reason to hesitate to ask for help.”
The Collegiate School already has asked Davis to meet with the next class of seniors in the fall to provide them with a realistic overview of nursing. “It’s really an opportunity to reach out to high school students who have a particular interest in the sciences and educate them about how that interest can be transformed into a fulfilling career as a nurse researcher,” she says.
When the Barnes-Jewish Hospital neurosurgical innovation unit was in the works, the plan was to trial and then implement a variety of best practices directed at better patient care. Those practices deemed successful would be rolled out hospital-wide.
One year after opening, the unit is embracing the concept that better patient care starts with having leaders and caregivers who best align with the unit’s objectives.
One of the most innovative concepts was a program that created behavioral-based interview guides to select and develop staff for the unit.
“Nursing leaders and staff were hired based on the same competencies, but modified to their role. Everyone had to be willing and enthusiastic to try new things, speak up and escalate any concern for the sake of improvement,“ says Liz Pratt, DNP, RN, ACNS-BC, research scientist and clinical nurse specialist.
The focus on hiring the right team was right on target. The unit is ranked in the 83rd percentile in overall quality of care when compared to like units by Professional Research Consultants, Inc. (PRC). This means it is performing higher than 83 percent of the neurological units across the country who are in the PRC database.
Another part of the unit’s success is the Marbella care management rounding tool. The assistant nurse managers round on (visit without being called for) patients daily just like other floors, but unlike other units, the questions are geared toward clinical care and patient expectations.
Clinical milestones such as achieving pain control and removing urinary catheters are monitored within specific timeframes. The milestones for patient expectations ensure that staff help patients understand expectations of their care, confirm whether our goals match up with their goals, and whether patients know their discharge date.
“Patients are tracked for the entire length of their stay; it’s not a one and done,“ says Pat Potter, RN, PhD, FAAN, director of research for patient care services. “A report is available on each patient to see if they are having success and, if they’re not, we can adjust to make improvements.“
Another success Potter refers to is each patient’s journey through the mobility program. Patients are placed on a mobility protocol once they reach 11300. There are four levels of mobility:
Developed by the unit’s nurses, a sign displaying the mobility levels is kept within patients’ view as a reminder of their goals. The current average time all patients reach level four is 14.9 hours after surgery. According to Potter, at discharge, 93.8 percent are at level four. A few are in wheelchairs because they are not able to walk.
Christina Ward, BSN, BS, CMSRN, clinical nurse manager for the unit, reiterates the importance of the mobility program. “It helps prevent complications for patients down the road and has enhanced the relationships between caregivers and patients with more dialogue contributing to the success of the reduction in falls. The nurses have been diligent about interventions and safety measures.“
Ward sees a huge level of engagement with her staff. “We have an amazing team of nurses, patient care technicians, therapists and unit secretaries, and they have really owned the culture of safety. They share ideas on the board in the break room and many of our nurses participate in the UPC,” says Ward. Evidently, the feeling is mutual. The unit is using the Leadership Empowering Behavior Scale, which asks staff to evaluate the leader in the categories of:
Enhances meaningfulness of work
Facilitates goal accomplishment
Fosters participation in decision making
In the first survey, Ward received an above average score for all three categories.
Potter, Pratt and Ward believe the success of the unit has a common denominator – the staff, specifically the hiring of the right staff, which leads back to the interview guides that were created for 11300. The guides have been used for the hiring of all nursing positions since Sept. 1.
Says Pratt, “A few hiring managers had been using behavioral-based interviewing. Now all nursing leaders have transformational competencies combined with behavioral-based interviewing, improving the consistency at Barnes-Jewish. This best practice can only result in more engaged units and leadership, and improved patient care.
“It’s exactly the kind of question we need to answer in the lab.“