1. Edwards, Allison P. DrPH, RN
  2. Thomas, Lisa W. DNP, RN

Article Content

The Institute of Medicine's core competencies and American Association of Colleges of Nursing essentials can be effectively integrated by RN-BSN faculty using hospital-based quality improvement (QI) projects to ensure that students achieve transformative, distinctive experiences that engage them in application of evidence-based research. Students, faculty, and interdisciplinary staff from an inpatient rehabilitation hospital engaged in brainstorming to identify a priority QI project for student fulfillment of a capstone styled course that bridges theory and high-level practice in their final semester. This resulted in 2 separate, consecutive cohorts' cumulative effort. Each cohort was introduced to Institute for Healthcare Improvement's online modules and Six Sigma principles to foster concepts of QI. The first cohort completed an Ishikawa (cause-effect) analysis and literature review of evidence-based neurogenic bowel practice management. The development of 4 separate neurogenic bowel management algorithms integrating care based on physiological indicators, assessment, and medication interventions ensued. (Supplemental Digital Content,, provides algorithms for Constipation, Rectal Exam, Impaction, and Diarrhea as examples.) After obtaining interdisciplinary consensus and approval, students in the second cohort completed human subjects and electronic health record training and conducted staff education for pilot study implementation. Following Institutional Review Board approval, faculty guided students in the development of a data collection tool to measure algorithm indices and patient outcomes (Supplemental Digital Content, Table S1 Bowel Status Chart Audit). At project completion, students gained skills in critical thinking and judgment, informatics, QI processes, research principles, and interdisciplinary professional communication, and a perspective on how evidence-based practice informs patient safety and quality.