Developing an Advanced Pharmacology Course for DNP Students with Diverse Needs

1
Developing an Advanced Pharmacology Course for
DNP Students with Diverse Needs

• Elizabeth M. Rash PhD, ARNP, FNP-C
• Assistant Professor
• DNP Coordinator
• College of Nursing
• University of Central Florida
• Orlando, Florida

2
Presentation objectives

• Objective 1 understand the complexities of
  designing a course for students from diverse
  backgrounds with diverse needs
• Objective 2 describe the AACN Essentials of
  Doctoral Education for Advanced Nursing Practice
  applicable to an advanced pharmacology course
• Objective 3 identify key factors in developing a
  successful DNP advanced pharmacology course

3
Background

• 45 credit hour DNP program
• Placement in curriculum
• 2nd semester
• Blended mode 3 credit hour class
• Meets F2F every other Friday
• Alternate weeks online

4
Background

• 1st DNP Cohort
• 22 part-time post-MSN APNs
• ANP (4)
• FNP (15)
• PNP (0)
• CNS (2)
• CRNA (1)
• Experience levels varied
• 40 acute care practice
• 60 primary outpatient care practice

5
The Essentials of Doctoral Education for Advanced
Nursing Practice
Paraphrased from http//www.aacn.nche.edu/DNP/pdf/
Essentials.pdf

• DNP Essentials for all graduates of a DNP
  program regardless of specialty/functional focus.
  
• Competencies should not be interpreted to mean
  that a separate course should be offered for each
  of the DNP Essentials.
• Curricula differ in emphases based on specialties
  for which students are being prepared

But what if the program prepares multiple
specialties?
6
The Essentials of Doctoral Education for Advanced
Nursing Practice

• All 8 Essentials integrated throughout our
  curriculum the Advanced Pharmacology course
• Adv. Pharm. emphasis Essentials I VIII
• Essential I Scientific Underpinnings for
  Practice
• Essential VIII Advanced Nursing Practice

7
Advanced Pharmacology course objectives

• Apply pharmacodynamic pharmacokinetic
  principles in the clinical setting. (E I, VIII)
• Synthesize evidence based practice in the
  pharmacotherapeutic decision making process. (E
  III, IV)
• Apply pharmacotherapeutic principles for complex
  patients throughout the lifespan. (E I, VI, VII,
  VIII)
• Critique the process of drug design
  development. (E II, V)
• Analyze evaluate ethical issues in pharmacology
  (E I)
• Evaluate the impact of economics, health care
  policies health care systems in the
  pharmacotherapeutic decision making process. (E
  I, II, V)
• Analyze evolving trends in pharmacology (E I,
  III)

8
Advanced Pharmacology course objectives
Essentials actualized

• Topic Drug design development
• Essentials II Organizational Systems
  Leadership for Quality Improvement Systems
  Thinking V Health Care Policy for Advocacy in
  Health Care
• Actualization
• Resources Text Angell, M. (2005).  The truth
  about the drug companies
• Assessment Discussion RD of a selected drug

9
Advanced Pharmacology course objectives
Essentials actualized

• Topic Application of pharmacodynamics
  pharmacokinetics in the clinical setting
• Essentials I Scientific Underpinnings for
  Practice VIII Advanced Nursing Practice
• Actualization
• Resources Pharm. text (DiPiro), online sources,
  lecture
• Assessment Exam, case study analysis

10
Advanced Pharmacology course objectives
Essentials actualized

• Topic Drug interactions the CYP450 system
• Essentials I Scientific Underpinnings for
  Practice VIII Advanced Nursing Practice
• Actualization
• Resources Text (DiPiro), online sources, lecture
• Assessment Exam, case study analysis

11
Advanced Pharmacology course objectives
Essentials actualized

• Topic Drug resistance
• Essentials I Scientific Underpinnings for
  Practice VII Clinical Prevention and Population
  Health for Improving the Nations Health VIII
  Advanced Nursing Practice
• Actualization
• Resources Text (DiPiro), online sources, lecture
• Assessment Small group work, exam

12
Advanced Pharmacology course objectives
Essentials actualized

• Topic Pharmacogenetics
• Essentials I Scientific Underpinnings for
  Practice VII Clinical Prevention and Population
  Health for Improving the Nations Health VIII
  Advanced Nursing Practice
• Actualization
• Resources Text (DiPiro), online sources
• Assessment Small group work, exam

13
Advanced Pharmacology course objectives
Essentials actualized

• Topics Pharmacoeconomics
• Essentials I Scientific Underpinnings for
  Practice II Organizational Systems Leadership
  for Quality Improvement Systems Thinking V
  Health Care Policy for Advocacy in Health Care
• Actualization
• Resources Text (DiPiro, Angell), online sources
• Assessment Discussion pharm. cost
  benefit-analysis decision making

14
Advanced Pharmacology course objectives
Essentials actualized

• Topics Health care policies and systems their
  impact on prescribing practices
• Essentials I Scientific Underpinnings for
  Practice II Organizational Systems Leadership
  for Quality Improvement Systems Thinking V
  Health Care Policy for Advocacy in Health Care
• Actualization
• Resources Text (DiPiro, Angell), online sources,
  guest lecture NP/pharm. industry
• Assessment Discussion HCP pharm. dilemma
  possible interventions

15
Advanced Pharmacology course objectives
Essentials actualized

• Topic Pharmacoethics
• Essentials I Scientific Underpinnings for
  Practice VII Clinical Prevention and Population
  Health for Improving the Nations Health
• Actualization
• Resources Text (Angell), online sources
• Assessment Debate pharmacologic ethical dilemma

16
Advanced Pharmacology course objectives
Essentials actualized

• Topic Off label prescribing practices
• Essentials I Scientific Underpinnings for
  Practice III Clinical Scholarship and Analytical
  Methods for Evidence-Based Practice
• Actualization
• Resources Text (DiPiro, Angell), online sources
• Assessment Discussion off-label prescribing
  regulations, experiences, safeguards

17
Advanced Pharmacology course objectives
Essentials actualized

• Topic Evidenced based practice prescribing
  practices
• Essentials III Clinical Scholarship and
  Analytical Methods for Evidence-Based Practice
  IV Information Systems/Technology and Patient
  Care Technology for the Improvement and
  Transformation of Health Care
• Actualization
• Resources Text (DiPiro), online sources
• Assessment Discussion pharm. EBP practice
  guidelines for selected disease/condition

18
Advanced Pharmacology course objectives
Essentials actualized

• Topics Pharmacotherapeutics for complex patients
  throughout the lifespan
• Essentials I Scientific Underpinnings for
  Practice IV Information Systems/Technology and
  Patient Care Technology for the Improvement and
  Transformation of Health Care VI
  Interprofessional Collaboration for Improving
  Patient and Population Health Outcomes VII
  Clinical Prevention and Population Health for
  Improving the Nations Health VIII Advanced
  Nursing Practice
• Actualization
• Resources Text (DiPiro, Angell), online sources,
  lecture w/ exemplar
• Assessment Student complex case presentations
  paper (integration of all prior learning)

19
(My) Course Expectations

• Students will have basic knowledge of
  pharmacodynamics/kinetics (pd-pk)
• Students will have pd-pk application experiences
  (current prescribing experiences)
• Student will have common learning needs/interests
• Students will bring unique experiences
  perspectives

20
Student Expectations

• Increased depth of knowledge on SPECIFIC drugs
  SPECIFIC to their practice area
• We are already experts

21
Student Summative Evaluation

• Most beneficial
• Pd-pk, drug interactions, case studies
• Least beneficial
• Pharmacoeconomics, health care systems policy
• Mixed review
• Complex patient cases, online discussions

22
Challenges identified

• Student heterogeneity
• Prior knowledge (more homogenous post-BSN)
• pd-pk etc.
• Prescribing experiences
• specific drugs
• Current clinical patient contact
• not at bedside or limited patient contact
• Prior knowledge (expert) limited new learning
• Instructor knowledge
• Discussions, grading

23
Potential fixes

• Address (student/course) expectations at onset
• Review EBP ways of knowing at onset
• Review role of DNP (aggregates advocates)
• Consider topic flexibility based on class mix
  (but maintain all current topics)
• Increase case study discussions
• Change complex patient case to medication review