Development and Preliminary Evaluation of a Comprehensive Ambulatory Care Curriculum for Baccalaureate Nursing Students

Purpose: This project aims to provide care coordination and transition management (CCTM) education and training to pre-licensure nursing students to strengthen preparation of students to practice in community-based ambulatory care settings.

Background: The current state of the health care system has shifted many roles for nurses from hospital settings to ambulatory care and community settings to meet patients' needs across the care continuum. These nursing roles require the development of unique knowledge, skills, and attitudes to improve CCTM in these environments. Few pre-licensure programs offer intentional education and training opportunities in ambulatory care settings. Through funding from the Health Resources and Services Administration (HRSA), a university-based school of nursing developed and implemented a comprehensive curriculum that includes didactic, clinical, and simulation components to strengthen pre-licensure nursing students' knowledge, skills, and attitudes for success in ambulatory care settings. This poster reports on learners’ perceptions of how the enhanced curriculum impacted their knowledge, skills, and attitudes toward ambulatory care in the didactic and clinical courses.

Methods: AAACN's Core Competencies for Ambulatory Care Nurses and Core Curricula in Ambulatory Care and Care Coordination and Transition Management were used as guides to develop the curriculum. Course objectives and outlines were created using an iterative approach with the grant team, comprised of educators and clinicians with expertise in CCTM, which were then reviewed by clinical partners to ensure relevancy. Similarly, topics for case studies were collaboratively identified and developed. Knowledge (competence), skills, and attitudes of learners were evaluated using the following measures: 1) a modified self-efficacy and performance in self-management support (SEPSS) survey (perceived competence) administered pre- and post-course, 2) a modified health care access tool that tracks the type of ambulatory care nursing experiences and skills during clinical (perceived skills), and 3) student reflections (attitudes). Data will be analyzed using descriptive statistics and thematic analysis. Enhancements to the accelerated BSN program were integrated into the clinical practicum experience and through didactic content in CCTM. Enhancements to the BSN program are being incorporated via an ambulatory care clinical course and a CCTM didactic course.

Results: A total of 63 students participated in the curriculum in spring/summer 2020 and another 80 students are currently engaged. Preliminary examination of pre- and post-SEPSS scores show significant differences in perceived improved ability to assess, assist, and engage in shared goal setting with patients. Learners report developing independence in skills involving care coordination, effective communication, COVID-19 assessment, and referrals. Qualitative data suggests that learners’ confidence towards CCTM improved and they felt positive about their ability to apply these skills into practice.

Conclusion/applications: This novel curriculum provides explicit education and training in ambulatory care that is often missing in pre-licensure nursing education, particularly skills in CCTM. Findings suggest that learners better understand the roles of ambulatory care nurses due to the opportunities provided in the curriculum and they are more confident about their ability to provide nursing care in ambulatory care settings. Future work will be directed toward augmenting this curriculum with additional learners and collecting a more comprehensive evaluation of their knowledge, skills, and attitudes.