Running head: OSP PROJECT

Organization Service Plan (OSP) Project: Advance Directives, Decision Making, and Healthcare Planning Team 4: Jody Foster, Amy Johns, Lindsey Ranstadler, Stephaine Ryan, and Laura Weberg, Ferris State University

OSP PROJECT Abstract

Students pursuing a Bachelor of Science in Nursing from Ferris State University were assigned the task of developing a local community healthcare service organization to meet the requirements for a Leadership in Nursing class. Learning objectives for the assignment include familiarization and application of knowledge regarding the structure and function of a variety of healthcare organizations. An informal environmental survey was undertaken to determine

trends, similar services and support capacity for the determined service. The service to be provided, the name of the organization, a mission statement, philosophy, organization goals and objectives were developed. Organization structure was composed and mapped and job positions were defined and described. Advertising methods and costs were researched and a job position advertisement was created. A budget proposal was drafted.

OSP PROJECT Organization Service Plan (OSP) Project: Advance Directives, Decision Making, and Healthcare Planning The purpose of this assignment is to facilitate the learning and application of knowledge regarding the structure and function of a variety of healthcare organizations from the point of view of the profession of nursing. It is comprised of the development of a local community healthcare organization, designed to provide a service of perceived need as determined by students in the Leadership in Nursing class; a class required for the Bachelor of Science in Nursing program at Ferris State University (Ferris State University, n.d.) After a brief environmental assessment, Team 4 of the Leadership in Nursing class determined that education regarding advance directives, healthcare planning, medical decision making, and appointment of healthcare advocates was a community need. This service will be delivered in the context of small, informal classes offered at a variety of locations and will serve community members aged 18 and older. The classes will provide the opportunity to complete basic advance directive forms with guidance from registered nurses. They will also offer opportunities for collaboration with elder-law attorneys for more complex situations and documentation. This paper describes the OSP project through Step 4 during which the job advertisement is created and the budget proposal is drafted. Step 1 Name of Organization/Service The name of our educational class series will be Vital Discussions-Advance Directives, Decision Making, and Healthcare Planning.

OSP PROJECT Environmental Assessment of Trends, Forces, Similar Services, and Agency Support Capacity

Nationwide, it is a well-documented fact that the average age of the overall population of the United States is increasing. (Administration on Aging [AOA], 1600). As the number of Baby Boomers increases, so does the need for education related to advance directives, decision making, and healthcare planning. Vital Discussions services will directly address this. Vital Discussions development team is made up of five registered nurses with experience in a variety of healthcare settings including inpatient acute care, outpatient infusion clinic, and case management. After discussion, it was determined that a common trend among all these healthcare settings was a lack of information and education to address medical planning resulting in more stress and decreased quality during acute care delivery. In addition, although a greater percentage of elderly clients is predicted, as well as a higher number with chronic, advanced, and/or terminal illness, this service should not be limited to only those populations, so the class will be offered to all community members aged 18 and over. In the assessed areas of Traverse City, Greenville, and Muskegon, Michigan, very few patients have documentation indicating their end-of-life choices or have knowledge of the term advance directive. In a few cases, a simple advance directive form called Five Wishes (Aging with Dignity, 2011) is given to patients upon inpatient admission. This is often a time of duress and not conducive to education or informed decision making. Online searches for similar services yielded links to forms available for download. These forms are somewhat lengthy and contain language that is most appropriate for clients with advanced reading level and/or education. Also, they are available to only those clients who have internet access and knowledge of its use. Local hospital websites provided education and links

OSP PROJECT to forms, however, it was determined that assistance would be necessary for most clients to

navigate these websites. Searches did not result in any classes of the type that Vital Discussions will provide. After interviewing a local attorney with knowledge of elder law, it was determined that support would be available for clients that would need additional services beyond those provided by Vital Discussions. (Hillock, K.A., personal communication, February 8, 2014) Mission Statement Our mission is to help community members 18 years of age and older make informed end-of-life decisions through advanced care planning. We will provide education, assistance, and guidance for empowered decision making regarding life-sustaining treatment options and through the process of choosing qualified and informed patient advocates. We will provide assistance in completion of basic legal documentation and facilitate client collaboration with appropriate professionals for completion of required documentation beyond the scope of Vital Discussions. Philosophy We believe in promoting client autonomy, dignity, and empowerment with regard to endof-life decision making through education and collaborative communication. We respect each client's personal beliefs and wishes and believe that it is the right of every person to have access to information to ensure that the quality of their life experience is consistent with their own personal values. We believe in the tenets expressed in the Code of Ethics for Nurses (ANA, 2010) and also in providing care delivered with the highest level of professionalism.

OSP PROJECT Step 2 Organization Goals and Objectives For the purposes of increasing community awareness regarding advanced care planning, life-sustaining treatment options, patient advocate designation, legally binding documentation, and empowered decision making, we at Vital Discussions have set the following goals and objectives: Goal 1: We want to provide education to a maximum number of interested community members aged 18 and over, in a relaxed atmosphere and at easily accessible locations. Objective 1a: We will offer educational classes in a relaxed, informal atmosphere. Our class environment will be physically comfortable, conducive to open discussion, and staffed by pleasant, informed, caring, qualified registered nurses. This will be subjectively measured by Vital Discussions leadership and staff. Determination of basic supplies and equipment will

be completed by March 20, 2014 for incorporation in budget development. Objective 1b: We will offer our classes at a variety of easily accessible locations which may include but are not limited to senior centers, local hospitals, senior living communities and relevant community centers. Effectiveness of this will be measured by documenting attendance at each class for further analysis after completion of four Vital Discussions classes in differing locations. Classes will commence in July of 2014. Goal 2: We want clients to have a comfortable and functional understanding of key terms and concepts.

OSP PROJECT Objective 2a: As part of the discussion and instructional process, staff will assess client

knowledge through teach-back of key concepts. This will be measured by the ability to- and ease with which clients are able to recall and teach the information back to staff or through class discussion. Completion will be ongoing throughout the Vital Discussions process. Objective 2b: Clients will be guided through the completion of their individual advance directive documentation. Completion of this documentation will indicate a measure of understanding of the concepts. Staff will be sensitive and perceptive to client understanding and autonomy. Completion will be ongoing throughout the Vital Discussions process. Goal 3: We want to connect clients with documentation- or education needs beyond the scope of Vital Discussions with legal guidance and/or representation. Objective 3a: A relationship will be developed between an elder-law attorney and/or law firm, based upon a shared mission and philosophy of client autonomy, beneficence, for the purposes of meeting client needs which are outside the scope of Vital Discussions classes. This objective will be completed by March 15, 2014. Objective 3b: The elder-law attorney or appropriate representative will be in attendance at Vital Discussions classes, or available via technology, for the purposes of consultation and follow-up appointment scheduling. Completion will be ongoing throughout the Vital Discussions process.

OSP PROJECT Step 3 Organizational Structure We have developed a matrix organizational structure to reflect our interdisciplinary and collaborative approach to project development (Yoder-Wise, 2014, p. 149). Decision-making is

decentralized but all communication is routed through the team leader to facilitate continuity and efficiency. Organization subunits were created for the purposes of specialization to help to divide labor and ease communication which is made challenging by the wide geographic dispersion of our members. The nature of the organizational structure and the job descriptions allow for flexibility and modification as needed to suit changes as they are recognized during implementation (see Appendix A for organization chart). Job Descriptions Vital Discussions job titles and descriptions were created to address the two-stage nature of project development. The first stage consists of the creation and development of the organization and its structure and the second stage is project implementation. Future positions that will exist within Vital Discussions include one or more Volunteer Nurse Educators and an Elder-Law Representative. These positions will not have any direct decision-making capability, will not be paid or benefitted positions and as such, are not listed here. Budget Director Director of Step 4, Part B of OSP project. Responsible for content development and submission to the Team Leader for incorporation into Step 4 of APA assignment. Collaborates with Marketing Director to develop community resources/locations for service delivery, event planning, fund raising, and donation solicitation.

OSP PROJECT Evaluates financial data pertaining to Vital Discussions, while making recommendations that fall under the short and/or long term budget plans. Marketing Director Director of Step 4, Part A of OSP project. Responsible for content development and submission to the Team Leader for incorporation into Step 4 of APA assignment. Collaborates with Education Outreach Director 2 to develop Volunteer Nurse Educator position.

Collaborates with the Budget Director on community resources/locations, event planning, fund raising, and donation solicitation. Education Outreach Director (1 of 2) Co-Director of Step 5 of OSP Project. Responsible for content development and submission to the Team Leader for incorporation into Step 5 of APA assignment. Collaborates with attorney resource/Elder-Law Representative and the Team Leader to develop educational content of service. Collaborates with Educational Outreach Director 2 on technological delivery of proposal to stakeholders (Step 5) and educational content of service. Education Outreach Director (2 of 2) Co-Director of Step 5 of OSP Project. Responsible for content development and submission to the Team Leader for incorporation into Step 5 of APA assignment. Collaborates with Marketing Director to develop Volunteer Nurse Educator position. Collaborates with Education Outreach Director 1 on technological delivery of proposal to stakeholders (Step 5) and educational content of service.

OSP PROJECT Team Leader Responsible for OSP Project APA paper writing and submission.

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Central communication hub for team members and Blackboard Discussion Board thread organizer. Maintains alignment with organizations mission, philosophy, goals, objectives and job descriptions. Develops relationship and communication with attorney resource. Collaborates with Education Outreach Director 1 and attorney resource for development and implementation of educational material. Step 4 Job Advertisement Vital Discussions will staff its educational classes with Volunteer Nurse Educators (VNE). This will not be a paid position but will provide an excellent service learning opportunity and will be marketed to students attaining a BSN or MSN who need service learning for degree completion. It will also be marketed to prospective job seekers who need experience and volunteer activities to add to their resumes. After discussion to determine practicality, effectiveness, cost, and appropriateness to scope of project, print advertising was chosen to publicize the available job position. Sizes, features, quantity, coverage, and price were compared. Ads in national nursing journals and local newspapers did not meet budget criteria since Vital Discussions is operated completely by volunteers and subsequently has very low cash flow.

OSP PROJECT Table 1 Comparison of print advertisement features and costs Type of ad Nursing journal Nursing journal Nursing journal Newspaper Coverage Size National Fullpage Half page Quarter page Fullpage Half page Quarter page 1/8 page 8x10 8x10 Quantity Run time N/A One run Price B&W-$3,925 Color-$5,920 National N/A One run B&W-$2,525 Color extra $1,800 Source

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Clinical Journal of Oncology Nursing Clinical Journal of Oncology Nursing Clinical Journal of Oncology Nursing Traverse City Record Eagle Traverse City Record Eagle Traverse City Record Eagle Traverse City Record Eagle Vista Print Online Vista Print Online

National

N/A

One run

Local

4 ads

To be determined To be determined To be determined To be determined N/A N/A

Color included in price-$7,156 Color included in price-$939 $490 B&W-$252 Color-$302 $25 $70

Newspaper

Local

1 ads

Newspaper Newspaper Flyer Flyer

Local Local Local Local

1 ad 1 ad 25 100

It was decided that full-page color flyers would be printed and distributed at the following community college and university campuses, all in Michigan: Ferris State University in Big Rapids, the University Center and the main campus at Northwestern Michigan College in Traverse City, Baker College and Muskegon Community College in Muskegon, and Montcalm

OSP PROJECT Community College in Greenville. Flyers will also be displayed at Munson Medical Center in Traverse City. (See Appendix B for job advertisement flyer.) Budget Proposal

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Considerations for budget calculation include the following (see Appendix C for Budget Spreadsheet): Supplies needed: Educational handouts Refreshments Computer access for standardized PowerPoint educational presentation No cost was attributed to this item. Computer access will be provided by Volunteer Nurse Educators or Vital Discussions leadership. Estimated operating expenses: Minimal. Vital Discussions is staffed and run by volunteers. Cash revenue will be obtained through fundraisers. Donations of supplies will be solicited in exchange for advertising. Elder law representative will be provided free of cost in exchange for the opportunity obtain referrals. Staffing: Strictly volunteer, no expense generated. No full-time employees. Variable staffing at educational classes Compensation for professional staff: Compensation will be in the form of service learning opportunity for completion of BSN or MSN requirements, or professional development for inclusion on resume or professional portfolio.

OSP PROJECT Hours of operation: Classes will be held the second Saturday of each month, alternating between morning sessions from 8:00-10:00am and afternoon sessions from 1:00-3:00pm. Vital Discussions will allow for flexibility in scheduling to accommodate demand and availability of facilities. Reimbursement:

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Vital Discussions will not seek reimbursement for services. It will be offered free to the public as a professional outreach program. Summary A team of five registered nurses, working in collaboration, surveyed their work environments and determined that a need existed for education and support for patients regarding advance directives, healthcare planning and end-of-life decision making. Using the information learned in a nursing leadership class, a basic, small organization was formed, named, and its mission and philosophy were declared. Goals and objectives for developed and listed for planning purposes. An organization structure and chart were developed and job positions defined and described. Job advertisement methods and costs were discussed and researched. A job advertisement was created and a budget proposal was drafted. This completes Step 4 in the creation, implementation, presentation, and evaluation of the Organization Service Plan project.

OSP PROJECT References

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Administration on Aging, (1600). Projected Future Growth of the Older Population [Webpage]. http://www.aoa.gov/Aging_Statistics/future_growth/future_growth.aspx#gender Aging with Dignity, (2011). Five Wishes [Brochure]. Retrieved from http://www.agingwithdignity.org/forms/5wishes.pdf American Nurses Association, (2001). Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/C ode-of-Ethics.pdf Ferris State University, (n.d.). Nursing: RN to BSN Completion Program BSN. [Webpage]. Retrieved from http://catalog.ferris.edu/programs/494/ Oncology Nursing Society. (2014). 2014 Media Kit. Retrieved from ONS: http://www.nxtbook.com/nxtbooks/ons/2014mediakit/#/1 Record Eagle. (2013). 2013 Local Media Kit. Retrieved from The Record Eagle: http://static.record-eagle.com/elements/Record-Eagle%20Media%20Kit%20%20Print.pdf Yoder-Wise, P.S., (2014). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Elsevier

OSP PROJECT Appendix A Organizational Chart

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Fund Raising

Attorney Resource/Elder -Law Representative

Community Resources

Event Planning

Team LeaderAmy

1 of 2

Technology /Literature Resource

Volunteer Nurse Educator Position(s)

2 of 2

OSP PROJECT

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Appendix B

Vital Discussions: Volunteer Nurse Educator

Who we are We are a small group of professional nurses who are passionate about making a difference in the lives of those we care for. One way we do that is by holding monthly discussions as part of an outreach to help people to understand health care planning. What we do In conjunction with an elder law office we provide educational sessions to the public free of charge, teaching them to make informed decisions about advanced care planning. Classes are open to all adults and are held at various locations monthly throughout the state. What you can do We are looking for qualified volunteers to help us in our mission to educate the public in advanced care planning. Sessions

Vital discussions- Advanced Directives, Decision Making & Healthcare Planning Ferris State University Amy Johns, RN- Team Leader Lindsey Ranstadler, RN- Marketing Director Laura Weberg, RN- Education Outreach Director Stephanie Ryan, RN- Education Outreach Director Jody Foster, RN- Budget Director 1201 S State St, Big Rapids, MI 49307 (231) 591-2000 vitaldiscussions@email.com

are held twice a month. Classes

are held in an informal setting with open discussion. This is an excellent opportunity for service learning or professional outreach!

Please forward letter of intent and resume to Lindsey Ranstadler, RN vitaldiscussions@email.com

OSP PROJECT Appendix C Table 2 Budget Proposal Spreadsheet Budget Proposal: Vital Discussions Per Month Revenues Patient Revenues TBD Expenses 0 Personnel Professional Non-personnel Supplies/materials Operating Expenses Food/beverage Advertising Total 0 Donations TBD Year End

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20 0 30 25 75 TBD: to be determined *: excluding funds from donations and/or fundraisers

240 0 360 100 700