1. Edwards, Anna Marie BSN
  2. Farrell, Kathleen DNSc, APRN, BC, CCNS
  3. France, Nancey PhD, RN

Article Content


(1) Create an active clinical nurse specialist (CNS) student learning experience to reduce or prevent Ventilator Associated Pneumonia (VAP). (2) Engage CNS students to learn how to change practice by implementing a system change: Research, develop, implement, and evaluate the outcomes of a Ventilator Bundle in a small rural institution.



Medical advances save many lives, but good, basic-based nursing care such as preventing VAP is more important than ever. VAP, a nosocomial infection associated with morbidity and mortality, is costly, preventable, and responsive to evidence-based nursing care. National collaborative initiatives using interdisciplinary teams are addressing VAP prevention. CNSs are an integral part of these teams, and CNS students need to prepare for this role.



As part of its 100,000 Lives Campaign, The Institute for Healthcare Improvement (IHI) advocated the use of live-saving interventions (bundles) to reduce or prevent VAP. A senior CNS student implemented the VAP bundle at a rural southeast midlevel facility with a senior BSN McNair Scholar and faculty mentor conducting research on the outcomes. CNS students are replicating the project in small, rural community hospitals.



The education project involves CNS students initiating a change in small, rural community hospitals to reduce or prevent VAP. The CNS students conduct site assessments, research "best practice," develop interdisciplinary partnerships to establish consensus on a ventilator bundle, and implement and evaluate patient outcomes.



(1) NNIS risk index rate decreased from 9.85% to 2.67%. (2) CNS students effectively integrate the role with active learning experiences that produce improved patient outcomes.



CNS students developed change agent, team building, and mentoring skills by actively implementing this transformation to "Best Practice." The implementation of the ventilator bundle achieved significantly better patient outcomes and was an effective tool to demonstrate the ability to change practice.


Implications for Practice:

The concepts and process can be applied to facilitate learning and be effective in any improvement effort.