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Baillie L, Bromley B, Walker M, Jones R, Mhlanga F Implementing service improvement projects within pre-registration nursing education: A multi-method case study evaluation. Nurse Educ Pract. 2014; 14:(1)62-68 https://doi.org/10.1016/j.nepr.2013.06.006

Bahn D Social Learning Theory: its application in the context of nurse education. Nurse Educ Today. 2001; 21:(2)110-117 https://doi.org/10.1054/nedt.2000.0522

Bandura A Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84:(2)191-215 https://doi.org/10.1037/0033-295X.84.2.191

Bandura A Self-efficacy: the exercise of control.New York: WH Freeman; 1997

Selective moral disengagement in the exercise of moral agency. 2002. https://tinyurl.com/glm79u4 (accessed 27 May 2020)

Batalden PB, Davidoff F What is ‘quality improvement’ and how can it transform healthcare?. Qual Saf Health Care. 2007; 16:(1)2-3 https://doi.org/10.1136/qshc.2006.022046

Baumeister RF, Leary MR The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117:(3)497-529 https://doi.org/10.1037/0033-2909.117.3.497

Benner P From novice to expert. Excellence and power in clinical nursing practice.Menlo Park (CA): Addison-Wesley; 1984

Carlin A, Duffy K Newly qualified staff's perceptions of senior charge nurse roles. Nurs Manage. 2013; 20:(7)24-30 https://doi.org/10.7748/nm2013.11.20.7.24.e1142

Chang E, Hancock K Role stress and role ambiguity in new nursing graduates in Australia. Nurs Health Sci. 2003; 5:(2)155-163 https://doi.org/10.1046/j.1442-2018.2003.00147.x

Chesser-Smyth PA, Long T Understanding the influences on self-confidence among first-year undergraduate nursing students in Ireland. J Adv Nurs. 2013; 69:(1)145-157 https://doi.org/10.1111/j.1365-2648.2012.06001.x

Christiansen A, Robson L, Griffith-Evans C Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education. J Nurs Manag. 2010; 18:(7)782-788 https://doi.org/10.1111/j.1365-2834.2010.01114.x

Coventry TH, Maslin-Prothero SE, Smith G Organizational impact of nurse supply and workload on nurses continuing professional development opportunities: an integrative review. J Adv Nurs. 2015; 71:(12)2715-2727 https://doi.org/10.1111/jan.12724

Craig L Service improvement in health care: a literature review. Br J Nurs. 2018; 27:(15)893-896 https://doi.org/10.12968/bjon.2018.27.15.893

Davis L, Taylor H, Reyes H Lifelong learning in nursing: A Delphi study. Nurse Educ Today. 2014; 34:(3)441-445 https://doi.org/10.1016/j.nedt.2013.04.014

Dinmohammadi M, Peyrovi H, Mehrdad N Concept analysis of professional socialization in nursing. Nurs Forum. 2013; 48:(1)26-34 https://doi.org/10.1111/nuf.12006

Draucker BC The critique of Heideggerian hermeneutic nursing research. J Adv Nurs. 1999; 30:(2)360-373 https://doi.org/10.1046/j.1365-2648.1999.01091.x

Duchscher JB A process of becoming: the stages of new nursing graduate professional role transition. J Contin Educ Nurs. 2008; 39:(10)441-450 https://doi.org/10.3928/00220124-20081001-03

Duchscher JEB Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. J Adv Nurs. 2009; 65:(5)1103-1113 https://doi.org/10.1111/j.1365-2648.2008.04898.x

Feng RF, Tsai YF Socialisation of new graduate nurses to practising nurses. J Clin Nurs. 2012; 21:(13-14)2064-2071 https://doi.org/10.1111/j.1365-2702.2011.03992.x

Fretwell JE Ward teaching and learning.London: Royal College of Nursing; 1982

Gadamer H-G Truth and method, 2nd edn. London: Sheed and Ward; 1979

Gignac-Caille AM, Oermann MH Student and faculty perceptions of effective clinical instructors in ADN programs. J Nurs Educ. 2001; 40:(8)347-353

Gollop R, Whitby E, Buchanan D, Ketley D Influencing sceptical staff to become supporters of service improvement: a qualitative study of doctors' and managers' views. Qual Saf Health Care. 2004; 13:(2)108-114 https://doi.org/10.1136/qshc.2003.007450

Gray M, Smith LN The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study. J Adv Nurs. 1999; 29:(3)639-647 https://doi.org/10.1046/j.1365-2648.1999.00932.x

Gray PD, Thomas D Critical analysis of ‘culture’ in nursing literature: implications for nursing education in the United States. In: Oermann MH, Heinrich KT (eds). NewYork (NY): Springer Publishing Company; 2005

Guba EG, Lincoln YS Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS (eds.). Thousand Oaks (CA): Sage; 1994

Hatlevik IKR The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. J Adv Nurs. 2012; 68:(4)868-877 https://doi.org/10.1111/j.1365-2648.2011.05789.x

Houghton CE ‘Newcomer adaptation’: a lens through which to understand how nursing students fit in with the real world of practice. J Clin Nurs. 2014; 23:(15-16)2367-2375 https://doi.org/10.1111/jocn.12451

Huybrecht S, Loeckx W, Quaeyhaegens Y, De Tobel D, Mistiaen W Mentoring in nursing education: perceived characteristics of mentors and the consequences of mentorship. Nurse Educ Today. 2011; 31:(3)274-278 https://doi.org/10.1016/j.nedt.2010.10.022

Jackson D, Firtko A, Edenborough M Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. J Adv Nurs. 2007; 60:(1)1-9 https://doi.org/10.1111/j.1365-2648.2007.04412.x

James B, Beattie M, Shepherd A, Armstrong L, Wilkinson J Time, fear and transformation: student nurses' experiences of doing a practicum (quality improvement project) in practice. Nurse Educ Pract. 2016; 19:70-78 https://doi.org/10.1016/j.nepr.2016.05.004

Johnson N., Penny J., Robinson D., Cooke M. W., Fowler-Davis S., Janes G., Lister S. Introducing service improvement to the initial training of clinical staff Retrieved 05.04.2012, 2012. 2010; https://doi.org/10.1136/qshc.2007.024984

Lindseth A, Norberg A A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci. 2004; 18:(2)145-153 https://doi.org/10.1111/j.1471-6712.2004.00258.x

Machin AI, Jones D Interprofessional service improvement learning and patient safety: A content analysis of pre-registration students' assessments. Nurse Educ Today. 2014; 34:(2)218-224 https://doi.org/10.1016/j.nedt.2013.06.022

Mackintosh C Caring: The socialisation of pre-registration student nurses: A longitudinal qualitative descriptive study. Int J Nurs Stud. 2006; 43:(8)953-962 https://doi.org/10.1016/j.ijnurstu.2005.11.006

Madden MA Empowering nurses at the bedside: what is the benefit?. Aust Crit Care. 2007; 20:(2)49-52 https://doi.org/10.1016/j.aucc.2007.02.002

Maben J, Latter S, Clark JM The theory–practice gap: impact of professional–bureaucratic work conflict on newly-qualified nurses. J Adv Nurs. 2006; 55:(4)465-477 https://doi.org/10.1111/j.1365-2648.2006.03939.x

Maslow AH Toward a psychology of being.Chichester: John Wiley and Sons; 1998

McGowan B Who do they think they are? Undergraduate perceptions of the definition of supernumerary status and how it works in practice. J Clin Nurs. 2006; 15:(9)1099-1105 https://doi.org/10.1111/j.1365-2702.2005.01478.x

NHS Improvement. Patient Safety Measurement Unit. 2017. https://tinyurl.com/y8pagbwq

NHS website. High impact actions for nursing and midwifery—the essential collection. 2010. https://tinyurl.com/yawpgcjy

NHS website. Releasing time to care, the NHS Productive Series. 2020. https://www.england.nhs.uk/improvement-hub/productives

Future nurse: Standards of proficiency for registered nurses.London: NMC; 2018

Ogier M An ‘ideal’ sister—seven years on. Nurs Times. 1986; 82:(5)54-57

Ó Lúanaigh P Becoming a professional: what is the influence of registered nurses on nursing students' learning in the clinical environment?. Nurse Educ Pract. 2015; 15:(6)450-456 https://doi.org/10.1016/j.nepr.2015.04.005

Orton H Ward learning climate: a study of the role of the ward sister in relation to student nurse learning on the ward.London: Royal College of Nursing; 1981

Potter J Representing reality: discourse, rhetoric and social construction.London: Sage; 1996

Potter P, Perry A Fundamentals of nursing, 5th edn. St Louis (Mo): Elsevier; 2001

Robson C Real world research, 3rd edn. Chichester: John Wiley and Sons; 2011

Salmon J The use of phenomenology in nursing research. Nurse Res. 2012; 19:(3)4-5 https://doi.org/10.7748/nr.19.3.4.s2

Schoessler M, Waldo M The first 18 months in practice: a developmental transition model for the newly graduated nurse. Journal for Nurses in Staff Development (JNSD). 2006; 22:(2)47-52 https://doi.org/10.1097/00124645-200603000-00001

Shafer L, Aziz MG Shaping a unit's culture through effective nurse-led quality improvement. Medsurg nursing. 2013; 22:(4)229-236

Smith N, Lister S Turning students' ideas into service improvements. Learning Disability Practice. 2011; 14:(2)12-16 https://doi.org/10.7748/ldp2011.03.14.2.12.c8377

Smith J, Pearson L, Adams J Incorporating a service improvement project into an undergraduate nursing programme: a pilot study. Int J Nurs Pract. 2014; 20:(6)623-628 https://doi.org/10.1111/ijn.12217

Standing M A new critical framework for applying hermeneutic phenomenology. Nurse Res. 2009; 16:(4)20-30 https://doi.org/10.7748/nr2009.07.16.4.20.c7158

Strouse SM, Nickerson CJ Professional culture brokers: nursing faculty perceptions of nursing culture and their role in student formation. Nurse Educ Pract. 2016; 18:10-15 https://doi.org/10.1016/j.nepr.2016.02.008

Thomas LJ, Revell SH Resilience in nursing students: an integrative review. Nurse Educ Today. 2016; 36:457-462 https://doi.org/10.1016/j.nedt.2015.10.016

van Manen M Researching lived experience. Human science for an action sensitive pedagogy.New York (NY): State University of New York Press; 1990

Welsh I, Swann C Partners in learning. A guide to support and assessment in nurse education.Cornwall: Radcliffe Medical Press Ltd; 2002

Wilcock P, Carr E Improving teaching about improving practice. Qual Saf Health Care. 2001; 10:(4)201-202 https://doi.org/10.1136/qhc.0100201w

Developing and sustaining nurses' service improvement capability: a phenomenological study

Subject Lead, Adult Nursing, and Senior Lecturer, Northumbria University, Newcastle upon Tyne

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Alison Machin

Professor of Nursing and Interprofessional Education, Northumbria University/Executive Member (workforce), Council of Deans of Health

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Background:

Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area.

A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants.

Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used.

Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the ‘model of self-efficacy in service improvement enablement’ was developed.

Conclusion:

This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

Embedding a nursing service improvement culture has been a focus of successive UK policy initiatives ( Craig, 2018 ), such as the NHS Safety Thermometers scheme ( NHS Improvement, 2017 ), the 2012 nurse-led quality framework Energise for Excellence, High Impact Actions for Nursing and Midwifery ( NHS website, 2010 ) and the NHS Productive Series ( NHS website, 2020 ). However, information about how nurses develop and sustain service improvement skills beyond their initial education is lacking.

Service improvement can be defined as ‘the combined efforts of everyone to make changes, leading to better patient outcomes (health), better system performance (care) and better professional development (learning) regardless of the theoretical concept or tool utilised’ ( Batalden and Davidoff, 2007:2 ).

In 2007, a national initiative to embed this learning in undergraduate programmes created many opportunities for pre-registration nursing students to develop these skills ( Johnson et al, 2010 ). Students involved in the initiative evaluated it very positively and subsequent studies suggest it enhanced their understanding of the practicalities of implementing service improvement activity ( Machin and Jones 2014 ). Johnson et al's (2010) study suggested that resistance from staff, lack of time and student status were barriers to the success of students' service improvement efforts. Despite challenges, service improvement learning and the opportunity to improve the patient care experience is valued by pre-registration students ( Smith and Lister, 2011 ), with classroom-based sessions seen as beneficial for learning ( Baillie et al, 2014 ; Smith et al, 2014 ). Educational programmes encompassing service improvement have helped prepare student nurses to make changes in practice when qualified ( Machin and Jones, 2014 ; James et al, 2016 ). However, little is known about the sustainability of this learning.

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‘Racism absolutely must not be tolerated’

STEVE FORD, EDITOR

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Changing practice 1: assessing the need for service improvement

22 February, 2016

Before implementing a change in practice, nurses require a systematic, evidence-based approach to identifying gaps in services and the need for change

In order to ensure the service they offer is of an appropriate standard, nurses need to know how to assess its quality, identify the need for change, and implement and evaluate that change. This two-part series offers practical guidance on how to bring about an evidence-based change in practice, and how to demonstrate the success, or otherwise, of that change. It uses the example of an initiative undertaken to improve medicines management in a hospice to illustrate the process. The article also illustrates how work undertaken in changing practice can form part of the evidence submitted in the nurse revalidation process. Part 1 considers how to determine when a change in practice is needed, how to assess and measure current practice, and identify gaps or weaknesses. Part 2 will discuss how to find out why the current practice is falling short of the desired level, and how to go about implementing improvements and measuring the effect of changes.

Citation: Carter H, Price L  (2016) Changing practice 1: assessing the need for service improvement.  Nursing Times ; 112: 8, 15-17.

Authors:  Helen Carter is an independent healthcare advisor; Lynda Price is a clinical governance and infection control facilitator, Helen & Douglas House, Oxford.

• This article has been double-blind peer reviewed
• Scroll down to read the article or  download a print-friendly PDF here
• Read part 2 of this series here

Introduction

Nurses have a responsibility to preserve safety; this is made clear in the revised code of conduct for nurses (Nursing and Midwifery Council, 2015a). The Code states that nurses must “take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures”.

Preserving safety involves protecting vulnerable people and ensuring patient safety by reducing errors, rectifying mistakes and reporting concerns immediately. This requires nurses to identify problems and their causes, and put in place changes that will improve safety and the quality of care; it can involve participating in clinical audits and reviews, and any other activity that results in changing practice. This two-part series provides practical advice for nurses wishing to make changes to practice, as well as suggestions for documenting and evaluating the resulting changes.

When nurse revalidation begins in April 2016, the NMC will expect nurses to provide evidence of how they practise effectively. This will involve written information, including personal reflections and feedback from colleagues and patients, and evidence of having undertaken continuing professional development (CPD). Bringing together the expectations from The Code (Nursing and Midwifery Council, 2015a) and How to revalidate with the NMC (NMC, 2015b), the article also aims to help nurses consider ways to use the evidence collated in service-improvement projects as part of the material submitted in their revalidation evidence.

Importance of reflective practice

The Royal College of Nursing (2010) has developed a set of eight principles to enable nurses to reflect on their own practice. Principle F highlights the need for evidence-based practice, where “nurses and nursing staff have up-to-date knowledge and skills, and use these with intelligence, insight and understanding in line with the needs of each individual in their care” (Gordon and Watts, 2011). More recently, in the Shape of Caring review, Lord Willis stated that: “Registered nurses and care assistants are required at all levels to adapt, support and lead research and innovation to deliver high-quality care” (Willis, 2015). His recommendations were influenced by the need to celebrate good care and build on the expertise and evidence base of existing clinical practice.

Evidence-based practice has been defined as: “the integration of best research evidence with clinical expertise and patient values” (Sackett et al, 2000). Implementing a change in practice involves collating a variety of information and analysing the findings against national guidance, service provision and patients’ views of their care.

Identifying the need for change

Nursing practice is continually changing and it is important to identify improvements and deterioration in practice, particularly if they affect patient safety. Identifying issues in practice relies on nurses using their clinical judgement and knowledge to collate relevant information, thoroughly analyse appropriate data and provide robust evidence for the success, or otherwise, of change (Benner, 2000).

Once the need for change has been noticed, the process of bringing about change can be thought of as a series of steps:

• What are we trying to achieve? A review of the relevant evidence-based practice for the particular area of healthcare.
• Are we achieving it? How does current practice measure up to local and national standards?
• Why are we not achieving it? A review of current systems and processes to discover why current practice is falling short.
• What can be done to improve things? Recommendations, timescales and strategies to bring about a change in practice.
• Have things been improved?

Re-audit of current practice and ongoing review to see whetherm change has been successful.

This article explains steps 1 and 2. Steps 3 to 5 will be discussed in part 2 .

What are we trying to achieve?

It is essential to assess current practice within national and local guidance, standards and expectations; this will help to reveal potential gaps in practice and give an indication of what needs to be the main focus of an audit. A range of tools, advice and standards is available that can be used as a baseline or framework for measuring practice. While it is not within the scope of this article to address these in depth, they may include:

• National Institute for Health and Care Excellence (NICE) guidelines;
• Scottish Intercollegiate Guidelines Network;
• National social care standards;
• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (part 3);
• NHS Commissioning Board Special Health Authority (responsible for patient safety);
• Professional-body standards and guidelines.

Measuring gaps in practice

Regular audits of the structure, processes and outcomes of service provision are key in measuring whether or not established criteria and standards are being met (Chambers et al, 2006). Even in the best services there is likely to be a gap between what is happening in clinical practice and what has been identified as good practice in national and local guidance.

Carey et al (2009) suggested that closing the gap between best evidence and current clinical practice has the potential to improve health outcomes. If a nurse identifies a gap in practice, evidence such as incident forms, complaints, observations made by staff, patients or the public may show whether it is more than an isolated case. Nurses should therefore explore all available evidence, and discussions with colleagues will help to confirm any gap or poor practice

Once clinical issues needing to be addressed have been identified, it is important to select the most appropriate method to measure the quality and standard that should be available to patients; each will have its advantages and disadvantages. The method used to gather information will depend on the aim of the project. Depending on the time, resources and level of support available, clinical leads may choose to use some or all of the following methods:

• Clinical audit;
• Service review;
• Seeking patient and staff feedback;
• Observation of practice;
• Literature review;
• Complaints review;
• Patterns of incident reporting;
• Primary and/or secondary research.

This series uses a case study of some of the processes used by a nurse who undertook a medicines-management audit in a hospice, outlined in Box 1. Clinical audit is “a quality improvement process that seeks to improve patient care and outcomes through a systematic review of care against explicit criteria and the implementation of change” (NICE, 2002). Based on the audit cycle, Fig 1 (attached) outlines the processes that can be followed to maintain a robust approach to any project. Since the process is a cycle, once an audit has been undertaken and the relevant changes made, a re-audit should be carried out to close the loop and evaluate how the service is performing after making changes.

Box 1. Case study: Investigating medication errors in a hospice

A nurse working in a hospice was studying for an infection prevention and control qualification. The assignment for a module on quality and clinical governance was to identify an area of practice in which the standards of care could be improved. This involved using clinical governance tools and techniques, such as clinical audit, risk management, change management and evidence-based practice.

Within the organisation was a steady flow of incident reports concerning medication errors. The nurse decided to look into the issue to see if she could find any patterns, causes or contributing factors that might reveal why the errors were occurring. With this information the nurse would be able to recommend a change in practice that would improve the quality of care patients received.

The nurse began by auditing incident forms from the previous 12 months. These were benchmarked against criteria in the National Patient Safety Agency (NPSA) patient safety incident reports. Using this information, the nurse analysed the current position of the organisation to identify any underlying causes for the errors.

The nurse felt supported by senior staff and undertook the audit with the full backing of the hospice, which viewed medication errors as valuable opportunities for learning on an organisational and personal level. The World Health Organization (2004) suggested that this response to reporting incidents is more likely to improve patient care than the reporting process.

With information gathered about the causes of errors, and collated evidence of best practice, the nurse would be able to make recommendations to reduce the risk or prevent further errors.

Are we achieving it?

Having identified the issue(s) to be audited, the next step in the process (Fig 1, attached) is to assess whether or not the organisation or an identified clinical area is achieving its aims, in this case, the safe administration of medication. It is imperative to analyse the existing situation; a number of tools such as those mentioned above can be used to determine whether the organisation is achieving a high standard of care and, if not, the reasons for this.

A strengths, weaknesses, opportunities and threats (SWOT) analysis can be undertaken to identify barriers and opportunities for change. This is an integral part of the planning stage, and can save time and frustration at later stages of the project. A SWOT analysis is easy to do, and provides an assessment of internal and external factors that can influence changes in practice. It can be used to support short-term clinical or organisational goals (NICE, 2007).

Table 1 (attached) illustrates a SWOT analysis reviewing potential organisational influences on the prevalence of medication errors in the hospice. In this case, the analysis demonstrated that the organisation was open, trusting, willing to learn from mistakes and share good practice. This attitude is reflected in nursing practice and the willingness of staff to report incidents.

Defining the scope

After the need for change has been identified, the project’s scope and aim need to be described. The scope highlights the area to be included and excluded from the review or audit, while the aim can be an overarching statement to determine the areas of interest. Examples of reflective questions to ask when defining the scope include:

• What is being measured?
• Is this an audit or review?
• What are the risks to patients, staff and the organisation?
• What is the benchmark?
• Are there any standards to indicate what should be achieved?
• Is a baseline audit required?

The rationale for the project needs to be clearly articulated. The hospice nurse identified the aim as being to reduce the risk of preventable medication errors, thus improving the quality and safety of care.

Documenting change

Records are a vital component throughout the process of change, in order to provide evidence of how issues were identified and why service aims were not being achieved; recommendations to improve practice; and to show that the service has improved. The nature of this cyclical process means that monitoring and ongoing reviews determine whether the change has had an impact on practice or not.

Having identified where practice is not meeting the required national and local standards, the next step it to find out why this is happening and what could be done to improve practice. This will be discussed in part 2 .

• Nurses are required to have up-to-date skills
• Evidence-based practice is a cornerstone of all healthcare
• As part of revalidation, nurses will need to provide evidence to support practice
• Regular audits of service provision will measure standards
• Audit/review cycle ensures high standards

Related files

240216_assessing-the-need-for-service-improvement.pdf, fig 1 the cycle of audit and reevaluation.pdf, table 1 swot analysis of the hospice.pdf.

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Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation

Affiliations.

• 1 Faculty of Health and Social Care, London South Bank University London, United Kingdom; University College London Hospitals, London, United Kingdom. Electronic address: [email protected].
• 2 Faculty of Health and Social Sciences, University of Bedfordshire, United Kingdom. Electronic address: [email protected].
• 3 Faculty of Health and Social Sciences, University of Bedfordshire, United Kingdom. Electronic address: [email protected].
• 4 University of Surrey, Guildford, Surrey, United Kingdom. Electronic address: [email protected].
• 5 University of Bedfordshire, United Kingdom. Electronic address: [email protected].
• PMID: 23867284
• DOI: 10.1016/j.nepr.2013.06.006

Background: Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations.

Aim: The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum.

Method: A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach.

Results: Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff.

Conclusion: Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential.

Keywords: Clinical practice; Dissertation; Evaluation; Service improvement projects; Student nurses.

Copyright © 2013 Elsevier Ltd. All rights reserved.

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• How, and under what contexts, do academic-practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol. Armstrong L, Moir C, Taylor P. Armstrong L, et al. BMJ Open. 2023 Oct 24;13(10):e077784. doi: 10.1136/bmjopen-2023-077784. BMJ Open. 2023. PMID: 37879689 Free PMC article. Review.
• Professional practice-related training and organizational readiness for change facilitate implementation of projects on the national core value system in care of older people. Carlsson ÕU, Wadensten B. Carlsson ÕU, et al. Nurs Open. 2018 Jul 13;5(4):593-600. doi: 10.1002/nop2.185. eCollection 2018 Oct. Nurs Open. 2018. PMID: 30338105 Free PMC article.

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Service Improvement Project

Paper completed for my Nursing degree dissertation. It discusses the implementation of a patients DNACPR status and its identification on a patients wristband. The text follows a hypothetical project to implement the service improvement within an NHS trust; including research, stakeholder engagement and change implementation at a ward level.

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Healthcare information systems (e.g., Bar Code Medication Administration (BCMA) system), have been adopted to deliver efficient healthcare services recently. However, though it is seem-ingly simple to use (scanning barcodes before medication), users of the BCMA system (e.g., nurses and pharmacists) often show non-compliance behaviors. Therefore, the goal of this study is to comprehensively understand why such non-compliance behaviors occur with BCMA system. Though comprehensive literature review, we identified 128 instances of causes, which were cate-gorized into the five categories: Poor Visual and Audio Interface, Poor Physical Ergonomic De-sign, Poor Information Integrity, Abnormal Situation for System Use, and User Reluctance and Negligence. The results show that successful use of a BCMA system requires supportive systems and environments, so it is more like an issue of the system, rather than that of an individual user or a device. We believe that the proposed categories could be applicable in investigating non-compliance behaviors in other healthcare information systems as well.

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Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level perfo...

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Using service improvement methodology to change practice, william gage lead nurse for practice development and innovation, imperial college healthcare nhs trust, london..

This article discusses the role of service improvement methodology in changing the quality of care delivered. It outlines the six-stage framework for quality improvement recommended by the NHS Institute for Innovation and Improvement. The reader is encouraged to complete a series of activities to plan and deliver a service improvement project. Potential challenges to the successful delivery of a service improvement project are also considered. The article concludes with an example of the use of the six-stage framework to improve the quality of urinary catheter care in one acute NHS trust.

Nursing Standard . 27, 23, 51-57. doi: 10.7748/ns2013.02.27.23.51.e7241R1

This article has been subject to double blind peer review

Received: 03 October 2012

Accepted: 16 November 2012

management - leadership - quality - change management - quality improvement - service improvement

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Oldham describes “death by research” as one of the barriers to effective reform of health services. 1 He is correct that established approaches to generating and using research often have little impact on efforts to improve care. But his assertion that the “culture of evidence” is incompatible with a culture of …

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In this section

Service improvement: an introduction, service improvement: discover and understand, service improvement: generate and develop ideas, service improvement: implementation.

Service improvement and transformation is best approached in a structured way.

This includes understanding the challenge, analysis, creativity and prototyping (testing to learn) techniques that that allow teams to develop innovative solutions. It’s an approach that uses your understanding of the needs of your patients, the wider population and your organisational and service requirements, to deliver the best care.

Firstly, you must understand what improvement is and what transformation is. Improvement is about making things (eg processes, systems, ways of working, behaviour, location) better. Transformation is about changing their form, appearance, or structure.

Three phases of service improvement

The patient experience is always central to this approach. There are three phases in the approach and three themes/activities that you need to consider.

The three phases are:

• Discover and understand
• Generate and develop ideas
• Implementation

Within each phase there are three things to consider:

• Stakeholder management : if you know who your stakeholders are then you will be able to identify and raise potential issues and challenges more easily. Remember that patients, carers and staff are key stakeholders in any change and improvement work.
• Measurement and evaluation : monitoring your project ensures you know the difference you have made or are making.
• Sustainability : will you be able to maintain the improvements you are making?

You can apply this approach across a range of projects. These might be small improvements or larger organisational or system transformations. The framework will help you to develop innovative solutions to the challenges faced in delivering health and care.

There are a range of different tools and models to use for improving and transforming services. It’s always a good idea to check if your organisation has a particular model or approach. The local approach should include all the elements described within this framework.

• Push yourself out of your comfort zone: think differently and be creative
• Test out new ideas early: fail often and learn to develop innovative solutions
• If you are unsure about what to do, remember that someone will have been there before, so talk to them
• Take responsibility for what you achieve
• Have fun: being creative and innovative should be enjoyable!

Further information

• NHS Institute for Innovation and Improvement Service Improvement handbook : 75 tools and technique for service improvement which have been used in health and care.
• NHS Institute for Innovation and Improvement Improvement Leaders Guides : 15 guides covering the themes of General Improvement Skills, Process and Systems Thinking and Personal and Organisational Development. They provide practical advice on service improvement in health and care.
• The Health Foundation Quality improvement made simple : an overview of approaches to health care quality improvement.
• NHS England Leading Large Scale Change : a guide to help all those seeking and leading transformational change in complex health and social care environments.

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Service improvement and transformation

Service improvement and transformation include empowering staff to take on a wider range of clinical tasks. Here the matron should:

• gain support from the senior management team for staff to take on a wider range of clinical tasks
• allocate protected management time to Band 7 leaders and hold regular one-to-one meetings with them
• carry out talent mapping and training needs analysis (TNA) relevant to the personalised and department development plan, checking that all staff are ready and committed to life-long learning
• provide development opportunities to all, ensuring all staff are given equitable access to development that meets their specific needs and requirements
• ensure the TNA and education programme cover the development of nurse consultants, advanced nurse practitioners, emergency nurse practitioners, midwives, all levels of clinical nurse specialists, Band 7 leaders who empower the Band 5 and 6 staff to support and develop the Band 2 to 4 staff
• encourage continuous quality improvement and be a change agent
• share learning and knowledge with other organisations
• motivate others to give the highest quality care
• engage with primary care partners and community services.

Quality improvement

Quality improvement (QI) is ‘a systematic approach to improving service quality, efficiency and morale – not just a mechanism to solve problems in failing parts of the organisation. It is a way of expanding improvement beyond organisational or functional boundaries, so that impact is possible across the wider health and social care system’.45 Various QI programmes and accreditation schemes are available; trusts should choose the most appropriate for their circumstances. QI programmes are a means of achieving clinical effectiveness and encouraging collaboration in clinical areas.

What are the benefits of QI?

The literature about nurse involvement in QI highlights benefits to patients and to staff. Patient harm is reduced, operational performance improves, and financial savings can be made. Staff satisfaction increases, and staff sickness absence reduces. Trusts taking part in NHS Improvement collaboratives have benefited in many ways: the table below contains links to examples.

Matrons have a pivotal role in QI as they are the link between the executive nurse and frontline staff. They can help in measuring current practice against best practice and monitoring improvement. They can encourage staff to suggest ideas for improving services, allocate resources to improvement projects and support staff to test change on a small scale before rolling it out. This may include administrative support and providing an objective view of everyday practice.

Matron’s Handbook – next sections

• Appendix: The matron’s developmental framework and competencies
• Acknowledgements

Department of History

College of Social Science

History PhD Candidate Spotlight: NAEd Spencer Dissertation Fellow Gloria J. Ashalou

Posted on August 14, 2024 August 14, 2024 Author mcdon625

 By: Patti McDonald 

Gloria J. Ashaolu, a Michigan State University History PhD candidate majoring in African American history with minors in U.S. history and Black comparative/diaspora history, was recently named a 2024 National Academy of Education (NAEd)/Spencer Dissertation Fellow.   

This prestigious fellowship was only offered to 35 graduate students nationwide. The fellowship supports these students with the writing phase of their dissertation. The fellowship is comprised of three key components: fellows receive $27,500 for one academic year (distributed in two installments), students participate in two professional development retreats facilitated by NAEd members and other distinguished scholars, and have the opportunity of selecting an NAEd member or another respected scholar as their mentor to offer advice and assistance during the school year. 

We sat down with Gloria and asked her about her dissertation, how grateful she is for being recognized as a NAEd/Spencer Fellow, and why she decided to major in African American history and minor in U.S. history, and Black comparative/diaspora history. 

What were you thinking when you found out you were awarded The NAEd/Spencer Dissertation Fellowship?   

I was overwhelmed with joy and a deep sense of gratitude. 

What is this fellowship going to allow you to do? How is it so helpful you received this?   

The financial support from the NAEd/Spencer Dissertation Fellowship alleviates the need for significant employment and will allow me to dedicate more time to my dissertation—toward meeting the goals I set for my time to degree trajectory. I am also immensely grateful for the unique opportunity to engage with members of my cohort and distinguished scholars in the field of education at the two professional development retreats organized by the National Academy of Education. Participating in the discussions and sessions will provide me with the resources and insight to meaningfully contribute to the field and the improvement of education. Furthermore, fellows are paired with mentors who will provide further research and career development over the academic year.  

What is your dissertation about? Tell us about it in a few sentences.   

Between the late 19 th and early 20 th centuries, the model of educational vision Black teachers fostered and were deeply committed to greatly mirrored what we today regard as anti-racist systems of knowledge and educational practices. My dissertation attends to the understudied educational activism, pedagogies, and praxes of local Black teachers during the Early Black History Movement through a biographical analysis of the life and times of Jane Dabney Shackelford, a Black female educator from Terre Haute, Indiana who was most active during the era of Jim Crow segregation. The educational trajectory and systems of teaching Shackelford and her peers embodied serve as a useful tool for conceptualizing the significant ways in which local schoolteachers cultivated an intentional educational and intellectual practice that challenged the beliefs, politics, and policies of Jim Crow segregation. Driven by what Anna Julia Cooper referred to as the “moral forces of reason and justice and love,” these educators inspired Civil Rights Movement participants, Black Power Movement activists, and Black Studies revolutionaries.  

Why is this type of research so important?   

Amid the regime of violence, discrimination, and disfranchisement of Jim Crow segregation, local Black teachers played critical roles in the lives of countless Black youth by educating them about their rich history, heritage, and culture. This study situates the underappreciated presence and pedagogies of these educators within their rightful historical legacy. The first contribution of this project entails the study of the life and times of an influential—yet understudied—historical actor as a window into the education-activism of Black teachers during the Early Black History Movement. Second, this project attends to the principles and conventions of Jim Crow North, by challenging static, flattened, and selective narratives that loom in popular remembering of the era of Jim Crow segregation. Third, the use of the robust repository that makes up the Shackelford papers seeks to excavate the scholarly and intellectual work and the service ethos that guided her educational activism and that of her community of educators.  

Why did you decide to major and minor in African American history, U.S. history, and Black comparative/diaspora history?  

The decision to major and minor in African American history, U.S. history, and Black comparative/diaspora history in the Michigan State University History PhD program was inspired by the trajectory of my research, the opportunity to learn from leading scholars in the fields, and my aspiration to create meaningful historical work that helps us better understand the present through our collective history towards a just and inclusive society. 

    Who have been some of your mentors within the History department?   

My mentors within the department include my major Advisor, Dr. Pero G. Dagbovie (University Distinguished Professor of History, Associate Provost for Graduate and Postdoctoral Studies, and Dean of the Graduate School), and Dissertation Committee Member, Dr. LaShawn D. Harris (award-winning historian and Associate Professor of History). I am sincerely thankful for their instrumental guidance and supportive mentorship.  

    Anything else you would like to include?   

  I am also grateful to God for the scholar-friends in the Department of History and College of Education who have been thought-partners and for their community of support.  

Gloria J. Ashaolu 

More From Forbes

Starlab set to orbit above moscow’s missiles, if space truce holds.

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A Russian nuclear missile in Moscow's Red Square. The Kremlin is now developing nuclear-armed ... [+] spacecraft to threaten the Western space powers and space players like SpaceX. (Photo by Gavriil GRIGOROV / SPUTNIK / AFP) (Photo by GAVRIIL GRIGOROV/SPUTNIK/AFP via Getty Images)

The Kremlin’s threats to escalate Space War I - by firing its anti-satellite missiles against any allied spacecraft aiding Ukraine - are imperiling Western plans to loft a cluster of independent space stations into orbit.

Upping the stakes by developing nuclear-armed spacecraft that would skulk in low Earth orbit like stealth space assassins, Russia has cast a virtual mushroom cloud surrounding the planet.

Yet the globe-spanning partners co-creating the Starlab Space Station - which will glitter with next-generation technologies - say they are still on track to launch the new outpost aboard SpaceX’s revolutionary Starship rocket .

Starlab will be patterned after the International Space Station, built by an alliance of space-tech leaders based in the U.S., Europe, Japan and Canada, says Manfred Jaumann, head of Low Earth Orbit Programs at Airbus, a co-founder of Starlab Space LLC.

But unlike its forerunner, which was constructed over the course of a decade, via dozens of flights of the American Space Shuttle and Russian rockets, Starlab will be launched on a single mission of the colossal Starship capsule , Jaumann told me in an interview.

The three-deck Starlab, with circular interiors for astronaut habitats and space physics labs that echo the fantastical ringed station in Stanley Kubrick’s masterpiece 2001: A Space Odyssey , will instantly outshine the International Station, he predicts.

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The next-generation Starlab Space Station glitters with leading-edge technologies that will outshine ... [+] the International Space Station. (Rendering courtesy of Starlab Space LLC)

“A lot of the ISS technology started in the 80s, in the 90s, of the last millennium,” Jaumann muses. “The Starlab technology is incredibly more advanced than the ISS.”

Starlab, which has already sealed a pact with the European Space Agency to host ESA astronauts and spacecraft, will be open to spacefarers and scientists around the world - except for cosmonauts or cosmologists from the Russian Federation, Jaumann says.

The ISS was co-built by NASA and Roscosmos, ESA and JAXA, during a halcyon era of space collaboration with Russia, when Boris Yeltsin led a democratic revolution that briefly transformed the post-Soviet federation, says Jeffrey Manber, President of International and Space Stations at Voyager Space, the American co-founder of Starlab.

A space investor and visionary, Manber was briefly ensconced inside the Russian aerospace hierarchy during Moscow’s fleeting embrace of Western liberalism and internationalism, and even helped Moscow negotiate an agreement to co-construct the ISS.

Yet since then Russia has transformed itself into an outcast on the global stage with its campaign to conquer democratic Ukraine and warnings it could use nuclear weapons against any Western ally that directly enters the fray.

After Elon Musk rushed tens of thousands of Starlink satellite terminals into Ukraine, plugging the blitzed country back into the internet, President Vladimir Putin’s emissary began telling UN gatherings that Moscow could fire its missiles on SpaceX satellites.

An early prototype of SpaceX's Starship super-spacecraft. Starship will loft the Starlab Space ... [+] Station into orbit. (Photo by Loren Elliott/Getty Images)

Even more ominous - Musk recounted to his official biographer - Russia’s ambassador to the U.S. personally told him the use of SpaceX technology by Ukrainian designers of weaponised drones could impel Moscow to start detonating tactical nuclear bombs to end Kyiv’s resistance.

The U.S. Department of Defense, in its Nuclear Posture Review released around the same time, stated: “In brandishing Russia’s nuclear arsenal in an attempt to intimidate Ukraine and the North Atlantic Treaty Organization (NATO), Russia’s leaders have made clear that they view these weapons as a shield behind which to wage unjustified aggression against their neighbors.”

“Our goal,” the Pentagon added, is to “reduce the risk of a nuclear war that could have catastrophic effects for the United States and the world.”

Yet the Kremlin is stepping up its brinkmanship by developing spacecraft armed with plutonium warheads that would perpetually circle the Earth.

Rather than enter a nuclear arms race in space, Washington called out Russia’s clandestine project by introducing a resolution in the UN Security Council that sought to reaffirm the Outer Space Treaty’s ban on stationing atomic warheads in orbit.

A model of Russia's thermonuclear Tsar Bomb, the most powerful weapon ever created. Moscow is now ... [+] developing plutonium warheads that would perpetually circle the Earth. (Photo by NATALIA KOLESNIKOVA / AFP) (Photo by NATALIA KOLESNIKOVA/AFP via Getty Images)

Moscow’s abrupt veto of the resolution confirmed its “intention of deploying nuclear weapons in space,” declared White House National Security Advisor Jake Sullivan .

Yet the United States has no intention of matching Russia’s future nuclear orbiters by developing its own, says Spenser Warren , a scholar on Putin’s nuclear modernization drive at the University of California Institute on Global Conflict and Cooperation.

“We are entering a new era where it’s as easy to envision a conflict in space as a conflict on Earth,” Manber, one of the original conceptual designers of the Starlab Station, told me in an interview.

Manber says he hopes Roscosmos’s ongoing partnership in the ISS, which hosts Moscow’s cosmonauts, and the lofting of a flotilla of independent space stations piloted by astronauts across the globe, will prevent Russia’s Space Forces from launching attacks on orbiting spacecraft.

Yet scholars who focus on Russia’s drive to enhance its space weapons and nuclear arsenal say sending new Western space stations into orbit could actually embolden Putin and his militaristic cohort to escalate their threats against the allies.

“From a signaling standpoint, the presence of more independent U.S. space stations may make Russia more likely to threaten the use of ASAT weapons or a nuclear device in low Earth orbit,” says Warren, who is now transforming his doctoral dissertation, “Russian Strategic Nuclear Modernization Under Vladimir Putin ,” into a book.

The allies’ new orbital stations could fuel a revamped round of Russian “ASAT blackmail,” says Elena Grossfeld, an expert on Moscow’s military and civilian space programs in the Department of War Studies at King's College London.

The ring of new Western space havens “will make the threats of ASAT use more likely,” she told me in an interview.

The ban on Russian cosmonauts visiting the Starlab Station, she adds, could trigger the ire of Moscow’s political and space leadership.

Both space defense scholars agreed that Russia’s launch of a nuclear ASAT would overturn a decades-long consensus, reflected in the Outer Space Treaty, on preserving space as a demilitarised zone.

They also agreed there is a new, potentially auspicious portent on the horizon of future space missions and stations, paradoxically emanating from Moscow.

Roscosmos Chief Yury Borisov in July sketched out details of blueprints to fly the Russian Orbital Station , with the first two modules set to blast off in 2027, according to the government news agency TASS.

The 608-billion-ruble project would place cosmonauts on a long-lived platform circling the globe, and could therefore represent the Kremlin’s own deterrent to exploding conventional or nuclear ASATs above the Earth, say the Russian military experts.

Yet Warren told me in an interview that Russian strategic forces could still launch their nuclear-armed orbiter.

“Russia may still want to place a nuclear-armed weapon of some sort in space for a few reasons,” he says. “They may want to leverage its coercive abilities.”

Alternatively, he adds, “Russia may be placing a nuclear-armed weapon in space for status purposes: ‘Look at our new weapon with no analogues, not even in the U.S. or China!’”

Airbus executive Manfred Jaumann, meanwhile, says the Starlab allies are “now using astronauts to test out our mock-up of the Starlab Station in Houston.”

He adds the leading-edge AI/defense outfit Palantir is providing Starlab with a suite of artificial intelligence tools to operate the Station, including a next-generation automated collision avoidance system.

Starlab’s collision avoidance system, Warren says, might even enable the Station to change its trajectory to avoid being hit by a ground-launched Russian ASAT missile.

But that cutting-edge capability may depend on Starlab’s being linked up with an advanced missile warning/missile tracking system, he says.

Russia’s ongoing barrage of nuclear threats, combined with its staging of simulated nuclear war drills, are propelling an equal and opposite reaction around the world, with more countries signing or ratifying the UN Treaty on the Prohibition of Nuclear Weapons , according to leaders of the International Campaign to Abolish Nuclear Weapons.

ICAN was awarded the Nobel Peace Prize in 2017 for its role in mobilising “people all over the world to convince their governments to support a ban on nuclear weapons.”

ICAN credits a constellation of leading lights - stretching from Albert Einstein to Pope Francis - for the ultimate promulgation of the Treaty, which calls for the abolition of nuclear weapons from the face of the planet.

Einstein, the first super-icon of the anti-nuclear movement, was quick to recognize the threat posed to humanity and civilization by atomic arms, and began calling for a freeze on their deployment even before their first use in 1945.

Albert Einstein, super-icon of science, became the guiding star in the global movement to abolish ... [+] nuclear weapons. (Photo by Hulton Archive/Getty Images)

In a manifesto penned during his last days on Earth, Einstein, along with a circle of fellow Nobel Prize winners, warned: “The best authorities are unanimous in saying that a war with H-bombs might possibly put an end to the human race.”

After a decade of leading appeals to abolish atomic arms , Einstein made an even more radical proposal: universal military disarmament.

Even an agreement to dismantle nuclear weapons across the continents, he warned, would not prevent their resurrection in times of war.

Yet he added, in his last open letter to the world: “The abolition of thermonuclear weapons” would represent a remarkable “first step” toward long-term global peace.

“If you can do so,” Einstein predicted, “the way lies open to a new Paradise.”

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College of Graduate Studies

Physical Address: Morrill Hall Room 104

Mailing Address: College of Graduate Studies University of Idaho 875 Perimeter Drive MS 3017 Moscow, ID 83844-3017

Phone: 208-885-2647

Email: [email protected]

Dissertation/Thesis Support Group

Faculty member Dr. Ben Ridenhour  and Dir. of Grad Student Support Programs, will continue to facilitate a weekly dissertation support group aimed at candidate level doctoral students (though others are VERY welcome to attend, including those working on a thesis). The weekly meetings will involve goal-setting, trouble-shooting, and peer and faculty support activities. Get your dissertation finished with the support of your community and graduate!

Wednesdays:  2 - 3 p.m. Zoom at:   https://uidaho.zoom.us/j/83703483358

Thesis/Dissertation Formatting Workshop #1

Sept. 29, 2021

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Thesis/Dissertation Formatting Workshop #2

Oct. 13, 2021