To create safer systems and improve patient outcomes, leaders in health care have emphasized the need to improve lines of communication among all providers through interprofessional education (IPE).1-4 While some schools of nursing have begun IPE initiatives between nursing and medical students using tools such as TeamSTEPPS, the Institute of Medicine recommends that to best address the population's health promotion and disease prevention needs, IPE models should include a wider variety of professionals.5,6

Leaders in nursing also called for educators to radically reshape prelicensure clinical education from a predominantly acute-care, hospital-based model to one that is centered around common health problems and includes a variety of care settings.7,8 The need to transform pediatric clinical education is especially urgent. Children comprise approximately a quarter of the nation's population, but 17% have less than optimal health.9,10 Nurses, skilled in the care of children, can help improve care outcomes, but this care is increasingly happening in settings outside acute care.11,12 Inpatient pediatric units have been running at 73% capacity for several years, while at the same time visits to other outpatient care settings have increased by 26%.11 Experts in pediatric nursing affirm that children's health preferred future is dependent on the delivery of health promotion, disease and injury prevention, and healthy development where children live, learn, and play.11-13 Thus, aligning pediatric clinical education to the points where families access care is important.

Vision care is an important aspect of pediatric health promotion.14 Healthy People 2020 sets 3 objectives for improving vision in children: increasing the number of preschoolers who receive vision screening by 10%, reducing blindness and visual impairment in children and adolescents by 10%, and increasing the use of personal protective eyewear in hazardous situations among children and adolescents by 10%.14 Nurses often perform initial screenings and make referrals; thus, achieving Healthy People 2020 pediatric vision care objectives requires strong collaborative efforts between eye care specialists and nursing.

Intervention

To meet the curricular need to redesign pediatric clinical education and to increase IPE education, we piloted a clinical education experience for students in a baccalaureate nursing program (BSN) at a school of optometry's pediatric clinic. Consistent with Barr's4 IPE practice model, objectives were created for common, complementary, and collaborative competencies for the clinical experience. The common objectives, or those areas both nurses and optometrists need to know, were to describe common pediatric vision problems and screening techniques and use developmentally appropriate communication. Examining nursing's role in vision care was the complementary objective. Finally, the collaborative objective was to develop a common language for discussing vision care.

Over the course of the academic year, 19 junior BSN students, enrolled in a developing families course, spent 1 day at the pediatric optometry clinic. To prepare, the pediatric optometrist gave a 1-hour lecture on the role of the optometrist and what nurses need to know about vision problems and screening methods in children. The lecture covered the same content given to school nurses at their annual state meeting. The content included how to screen for common vision problems and what conditions optometrists could treat versus what care needs to be provided by an ophthalmologist.

During the clinical experience, the BSN students were paired with an optometry student. The team examined the pediatric patient together and presented their findings to the supervising optometrist. Then all 3 team members discussed the findings with the family. Nursing students completed a care plan and reflective journal about their experience. They also participated in postconference discussions with students assigned to other pediatric experiences that day.

Outcomes

Institutional board review approval was obtained to analyze materials generated as a part of course work. Review of the assignments and postconference discussions suggested that the nursing students gained an understanding of pediatric vision problems and screening techniques while developing IPE and pediatric communication skills. Students were also able to design care webs and collaborative plans for vision care (see Figure, Supplemental Digital Content 1, http://links.lww.com/NE/A205).

Discussion

Review of the evidence suggests that students were able to meet the defined IPE clinical objectives, but future revisions should include more direct measures of knowledge, skills, or attitude changes in both nursing and optometry students. Other possible measurements might examine outcomes in terms of interprofessional practice such as communication, intent to make appropriate referrals, and actual improvements in patient outcomes.

From a broader perspective, this project included several characteristics associated with high-impact educational practices. The pilot included collaborative learning; it was community-based; and it helped students apply what they had learned about pediatrics in a new setting.15 What it did not include were effort over time and substantive feedback. Looking to the future, we recognize the need to find ways to increase on-site nursing supervision. The nursing faculty, who also supervised students in the hospital, only met with the students in the optometry clinic during postconference. This limited the amount of feedback provided by the instructor. We also recognize the need to extend the experience beyond a 1-time event by continuing to seek opportunities for exposure to each other's discipline. Options discussed have included having optometry students teach vision screening to nursing students in health assessment while nursing students help optometry students with their IV skills.

Conclusions

Both nursing and optometry have stakes in promoting pediatric vision health. Healthy vision helps keep children safe on the playground, as they engage in sports and in other activities. While only a pilot, this project serves as an exemplar for how schools of nursing and optometry can work together to forward common educational and practice goals.

References