Developing a Profession Specific Statistics Course for Nurses

Jane Oppenlander School of Management The Bioethics Program Union Graduate College eCOTS, May 19-23, 2014 1

Evidence-based Nursing Practice

• Evidence-based practice (EBP) is an approach to nursing practice that makes use of the best evidence in making clinical decisions about patient care • Steps in the EBP process – Formulate a clinical question – Gather and critically appraise the best evidence – Integrate evidence with clinician expertise, patient condition and preferences and healthcare resources – Evaluate the practice change as a result of implementing the evidence • To meet the needs of practicing nurses, a graduate-level statistics course was designed covering traditional introductory statistics content with a healthy dose of research methodology and biostatistics 2

The Students and Their Motivation

• The students were experienced nurses: – Hospital administrators, floor nurses, nursing school faculty – Both bachelor’s and master’s prepared in nursing – Leading the implementation of evidence-based practice in their institution – Some pursuing advanced degrees • The nurses: – Valued the importance and role of statistics and research to achieve efficient healthcare delivery and quality patient care – Were dissatisfied with prior statistics courses, particularly on-line – Lacked confidence in their statistical capabilities – Were motivated to learn and wanted a classroom setting • Matthew et al (2013) report graduate nursing students have significantly poorer attitudes toward statistics than undergraduate nursing and non nursing majors based on the SATS-36 survey 3

Preparing to Design the Curriculum

• Investigate the nursing profession to make course relevant: – What is important to nurses? To their success?

– What kinds of problems do they encounter?

– Where are statistical studies used and needed?

– Where do they get their data?

– How and where do they report their findings?

• Consulted practicing nurses, nursing professors and researcher, and local healthcare professional organizations • Goal: – Create a graduate level statistics course where nurses can develop competence and confidence in applying statistics to the problems they encounter in their practice 4

Emphasize Statistical Literacy and Thinking

• Build statistical literacy by reading, writing and presenting statistical results – Examine abstracts to identify the important and essential statistical concepts – Read and summarize nursing research articles chosen by the students – All student learning assessments are the evaluation of written reports or oral presentations of the type they would be expected to produce in their profession • Statistical thinking is a shift from nurses’ intuition – Collect data from a survey, an operating process, and a design experiment – Evaluate the variability in the collected data graphically and numerically, addressing outlying observations – Examine in detail a published article whose focus is to quantify the variability in the cost of hip replacement (Rosenthal et al, JAMA Internal Medicine, Feb. 11, 2013) 5

Use Real Data

• There is an abundance of healthcare data available on the Internet – Federal (data.medicare.gov) and state (e.g., health.data.ny.gov) websites – Hospital acquired conditions are of interest to nurses • Falls, pressure ulcers, certain infections • Data used in the course: – Hospital acquired conditions from regional hospitals for assignments and classroom activities chosen by instructor – Contributed by students from nursing research and quality improvement studies in their hospital – Collected by students for class assignments – Obtained by students from the Internet for final project 6

Stress Conceptual Understanding

• Research Process – Types of health studies – cohort, randomized controlled trials – Difference between research and quality improvement studies – Design principles – randomization, blinding, balance – Levels of measurement – Principles and issues survey design • Statistics – Descriptive statistics and effective data presentation – Basics of statistical inference • Hypothesis testing, confidence intervals, p-values, statistical vs. clinical significance – Measure of disease frequency and risk • Odds ratio, relative risk, prevalence, incidence, … – Sample size, power analysis, and effect size – Comparative analysis • 2 sample t-tests, ANOVA, Chi-squared tests of association – Simple regression analysis and correlation 7

Foster Active Learning

• Classes are conducted in a workshop fashion – Driven by relevant nursing or healthcare problems – Students frequently work in small groups solving problems and present their results to the class for discussion – Ample time allowed for discussion of how the statistical techniques could be applied in their practice setting • Two of the datasets examined by the class came from students’ nursing practice • Student learning assessments – Focused on either actively producing (and analyzing) data or consuming statistical analysis – In many of the assessments, students choose the problem and data to be addressed, but not the form or length of the written product 8

Use Assessments to Evaluate Learning

• Conduct an at-home experiment • Develop and pilot a survey • Data collection from a process daily for 30 days • Journal article summary in lay language • Final project – empirical research project – Problem formulation, literature search, find data, analyze and interpret results – 1 page project proposal, 3 page paper and 15 minute in-class presentation – Students evaluate presentations and provide feedback 9

Use Technology

• All software used was chosen because it was available to students in their workplace – Excel with Data Analysis Add-in • Underestimated students’ Excel capabilities. Required preparation of examples, templates, and how-to guides – On-line calculators • • • Sample size determination Power analysis Statistical methods not available through Excel Data Analysis Add-in (www.vassarstats.net) – SurveyMonkey • Audio and Video – 200 countries, 200 years in 4 minutes – NPR All Things Considered segments on health care studies 10

Lessons Learned

• Make everything relevant to their profession – Topics covered, cases, problems, and data used • Be willing to learn from your students about their profession as they learn about statistics from you • Working in small groups solving problems was particularly effective • Developing confidence is as important as developing competence to produce workplace advocates for evidence-based practice • Organize material into self-contained modules so it can be reused in professional development settings such as short courses, seminars, etc.

• Seek feedback from students periodically throughout the course 11