Tim J. Bristol, RN, PhD, CNE 1

Transcription

1 Back to Basics with the NCLEX Test Plan Tim Bristol, RN, PhD, CNE Walden University Ext. 1 NCLEX in April 2010 What will and what will not change. Click In Faculty can use the NCLEX test plan to write curriculum and develop learning activities. A. True B. False C. Maybe 2008RN Practice Analysis for Test Plan April, 2010 assists the NCSBN in evaluating the validity of the test plan that guides content distribution of the examination RN Practice Analysis Practice Analysis Conducted every 3 years New NCLEX Test Plan every 3 years RN April PN April Determines content of test plan Reevaluates Areas of Client Needs NCLEX RN 2008 Practice Analysis The sample 12,000 nurses (up to 6 months post grad) 2051 surveys used 88.3% Female (down from 91.9% in 2005) Average age (down from in 2005) 18.6% Previous LPN/LVN (average of 5.3 years) 51.7% Previous aide Tim J. Bristol, RN, PhD, CNE 1

2 Characteristics of new graduates work environment RN S Hospitals 84% 89.2% LTC 7.6% 5.3% Community 5.5% 3.9% Other 1.3% 1.6% Practice Setting RN s Critical Care 31.3% 34.5% Medical surgical unit 40.4% 39.5% Pediatrics/nursery 62% 6.2% 74% 7.4% Labor/Delivery 4.3% 3.7% Post Partum 3.4% 3.9% LTC 6.2% 5.0% Participants could select more than 1 area of practice. Client Ages Older Adult (over 85 yrs) 25.8% 24.8% Older Adult (65-85 yrs) 58% 61.6% Adult (31-64 yrs) 58.1% 60.6% 6% Young adult (19-30 yrs) 23.5% 24.6 Adolescents (13-18 yrs) 10.5% 11.0% NB-Children (0-12 yrs) 11.0% 11.2% Click In When should we start discussing the NCLEX Test Plan with students? A. Semester 1 B. Semester 2 C. Final Semester D. Other NCLEX RN 2008 Practice Analysis Priority pp / Appx F Med Admin Rights Universal Precautions Client ID Changes for RN Management of Care % Safety & Infection Control % Health Promotion & Maintenance % Psychosocial Integrity % Basic Care & Comfort % Pharmacological & Parenteral % Therapies Reduction of Risk Potential % Physiological Adaptation % Tim J. Bristol, RN, PhD, CNE 2

3 Areas of Client Needs Safe Effective Care Environment Management of Care *** 2007: 13-19% 19% 2010: 16-22% Safety and Infection Control % % Management questions Determine priority of care for a group of clients. Determine priority of care for a client. Determine where/how clients room assignments are to be made. Delegate nursing assignments to other RN s (float, new graduate). Assign nursing care to LVN s and CNA s Determine most stable client to be moved for bed space. Areas of Client Needs Health Promotion and Maintenance 2007: 6-12% 2010: 6-12% Psychological Integrity 2007: 6-12% 2010: 6-12% Areas of Client Needs Physiological Integrity cont. Reduction of Risk Potential *** 2008: 13-19% 19% 2010: 10-16% 16% Physiological Adaptation 2008:11-17% 2010: 11-17% Level of Difficulty Good ole Bloom! Knowledge Comprehension Application Analysis Synthesis/Evaluation Level of difficulty is determined by the question construction not the level of difficulty of the content of the question. Want to increase difficulty not adding obscure information. Level of Difficulty NEW Bloom! Remember Understand Apply Analyze Evaluate Create Want to test how they think instead of what they know Tim J. Bristol, RN, PhD, CNE 3

4 Click In Students fail NCLEX primarily for a lack of knowledge about the content. A. True B. False NCLEX Resources ncsbn.org 2008 RN Practice Analysis, 2010 Test Plan 2006 PN Practice Analysis, 2008 Test Plan NCLEX-RN Test Plan, April 2010 NCLEX RN Examination Detailed Test Plan, 2010 (available in Jan, 2010) Candidate Bulletin Candidate Tutorial Identification Strategies Biometrics Picture, fingerprint, palm vein Forms of acceptable identification Driver s license State issued identification Military identification Passport Student Success NCLEX Test Plan NCLEX Hospital Nursing Care Nursing Process NCLEX Tutorial Sample Questions Associate the Tutorial with something happy/peaceful No Previous button on real exam Same tutorial students will take the day of the exam Any item may include charts/tables /graphs Multiple response (4-6 options, at least one is correct) Always tells how much rounding is required Prescriptions can be non-drug orders Tim J. Bristol, RN, PhD, CNE 4

5 NCLEX Questions What kind How many alternate format Pretest items RN - 15 within first 75 questions PN 25 within first 85 questions Click In Should we have Alternate Format questions on our in class exams? A. Yes B. No C. Maybe D. All of the above E. None of the above Alternate Format *** Audio questions Headsets will be provided Student will be advised when to put headset on for question Listen to audio and select an answer from the list provided Possible content: verbal communication, breath sounds, heart sounds The prices of corn have been rising steadily. The nurse is caring for a client who is having difficulty with elimination. After listening to the bowel sounds, what would be the best nursing action? (student applies head set and hears very loud gurgling bowel sounds in all 4 quadrants) 1. Further assess the abdomen and anticipate client may experience diarrhea. 2. Provide easy access to bathroom, the client should have a normal bowel movement within next few hours. 3. No action is necessary, the client s bowel sounds are normal. 4. Provide client with increased fluids and dietary fiber to prevent constipation. Alternate Format - Select all that apply: The nurse is caring for a 85 year old client who has a diagnosis of Mycoplasma pneumonia. What precautions will the nurse implement in assisting the client with morning care? Select all that apply: 1. Wear clean gloves. 2. Remove all extra suctions supplies from the room. 3. Dispose of gown and mask in container outside client s door 4. Wear a face mask when working within 3 feet of the client 5. Put on a gown prior to entering the room. 6. Remove the stethoscope from the room if it did not come in contact with the client. Tim J. Bristol, RN, PhD, CNE 5

6 The nurse is caring for a 85 year old client who has a diagnosis of Mycoplasma pneumonia. What precautions will the nurse implement in assisting the client with morning care? Select all that apply: 1. Wear clean gloves. 2. Remove all extra suctions supplies from the room. 3. Dispose of gown and mask in container outside client s door 4. Wear a face mask when working within 3 feet of the client. 5. Put on a gown prior to entering the room. 6. Remove the stethoscope from the room if it did not come in contact with the client. Alternate Format - ranking The nurse is caring for a client with pneumonia. He is dyspneic, his temperature is 102 º orally, and he is complaining of chest pain. In what order would the nurse provide care to this client? 1. Encourage clear liquids. 2. Administer humidified oxygen. 3. Place client in semi-fowler s position. 4. Administer antipyretic medication. 5. Instruct client regarding risk factors The nurse is caring for a client with pneumonia. He is dyspneic, his temperature is 102 º orally, and he is complaining of chest pain. In what order would the nurse provide care to this client? 3. Place client in semi-fowler s position. 2. Administer humidified oxygen. 4. Administer antipyretic medication. 1. Encourage clear liquids. 5. Instruct client regarding risk factors Fill in the blank all numbers Medication calculations IV fluid calculations Intake and output t Glascow coma scale No apothecary conversions Fill in the blank The nurse is completing the intake and output for a client who is 24 hours postoperative. The client has had the following intake and output for the shift: 4 oz orange juice 1000mL urine ½ scrambled egg 120mL drainage from ½ cup flavored gelatin T-tube 1 cup broth 400mL.45% normal saline, IV How many milliliters should the nurse document as the client s intake? Rules for Rounding Round answer to one decimal place. Perform rounding at the end of the calculation. Calculator type the numbers slowly, make sure calculator registers all numbers typed in. Units of measurement will be provided Answer: 1060 Milliliters Tim J. Bristol, RN, PhD, CNE 6

7 Hot Spot Graphic Graphics The nurse is caring for a client who is receiving Digoxin.25 mg every morning. On the graphic identify the correct location where the nurse would place the stethoscope to identify the client s pulse. X Chart/Exhibit A postoperative client tells the nurse he is hurting, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 6pm in the evening and the nurse is determining what can be done regarding the client s pain. Select the best answer based on the information in the chart. 1. Give 10mg morphine sulfate, IM now. 2. Medication cannot be administered. 3. Give 15mg morphine sulfate, IM now. 4. Give hydrocodone (Vicodan) 10mg PO Exhibit 1 Nurses Notes Exhibit 2 Physician orders Exhibit 3 Medication administration record. Exhibit 1 Nurses notes Information: 7am complaining of abdominal pain around area of incision; pain level 6, pain medication administered. 11am - sleeping throughout the day, lethargic, but easily aroused. 1pm complaining of abdominal pain around incisional area, pain level 5, pain medication administered, was free of pain and resting comfortably within 30 minutes. 4pm - remains comfortable. 5pm - beginning to complain of abdominal incisional pain. Exhibit 2 Physicians orders Physicians orders: Orders for the last 24 hours include: Morphine sulfate mg, IM, every 3-4 hours for severe pain. Hydrocodone (Vicodan) 10mg PO, every 3-4 hours moderate pain. Exhibit 3 Medication administration record (MAR) Morphine sulfate 10 IM administered at 7am Hydrocodone 10mg, PO administered at 1pm Tim J. Bristol, RN, PhD, CNE 7

8 Chart/Exhibit A postoperative client tells the nurse he is hurting, the nurse assesses the client and determines the pain is in the abdomen around the area of the incision, pain level is 6. It is 6pm in the evening and the nurse is determining what can be done regarding the client s pain. Select the best answer based on the information in the chart. 1. Give 10mg morphine sulfate, IM now. 2. Medication cannot be administered. 3. Give 15mg morphine sulfate, IM now. 4. Give Hydrocodone (Vicodan) 10mg PO now Exhibit 1 Nurses Notes Exhibit 2 Physician orders Exhibit 3 Medication administration record. Your Curriculum Implications Client Needs Safe and Effective Care Environment Management of Care Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity Basic Care and Comfort Pharmacological and Parenteral Therapies Reduction of Risk Potential Physiological Adaptation Your Curriculum Implications Integrated Processes Nursing Process Caring Communication and Documentation Teaching/Learning Questions? Tim J. Bristol, RN, PhD, CNE 8

9 Back to Basics Higher Order Thinking Creative Learning Strategies Tim Bristol, RN, PhD, CNE Walden University Ext. 1 Aim for HIGHER ORDER THINKING Level of Difficulty NEW Bloom! Remember Understand Apply Analyze Evaluate Create Want to test how they think instead of what they know CR x CR = CR 2 Clinical Reasoning is the goal Complex Relationships is the process Varied sources of data Similar options Prioritization Teaching IPO Instructional Design Input Data collection/analysis Process Analysis/synthesis Output Implementation/Assessment Self-reflection / Thinking-reflection IPO - Input Varied Input Anticipatory Set get ready Textbooks / Quiz / Remembering Media Experiences Interprofessional Collaboration Tim J. Bristol, RN, PhD, CNE 1

10 IPO - Process Analyze/Evaluate/Create Interpersonal/Collaboration Realistic Tech/Sim/Academia INVISIBLE IPO - Output Can be simultaneous with Process Analyze/Evaluate/Create Interpersonal/Collaboration Realistic Tech/Sim/Academia INVISIBLE Process-Collaboration Real Time Data Chat, Quiz, Vote Liveclasstech.com Click on Join Presentation Type in class code 10 CLICKERs Plugs into MAC or PC with no installation Can be imported into CMS gradebook Can be used to track attendance (give points for attendance) Can be used over any screen on the computer (Web Spreadsheet) Students can register their clicker during class or online. Saves images of Each Vote Engage Turn On Your Clickers Tim J. Bristol, RN, PhD, CNE 2

11 Aim for CREATIVE LEARNING STRATEGIES R-VARK Strategies Realistic Visual Aural Read/Write Kinesthetic Try to use multiple strategies at once and try to vary usage within the course. VARK Adapted from Neil Fleming Realistic Visual Look at practice / Involve practice (National Council does) What are the key issues? Remember/Understand is best for independent learning If using complex tools, try to simplify or repeat use Image / Video Created by - Vendor, Faculty, Student, Other Concept Maps Paper/Digital Read/Write Can be handwritten or typing Can be digital or paper Works best when combined with another strategy (realistic, visual, aural) Sometimes considered kinesthetic Kinesthetic From writing to walking Psychomotor Think about students in the classroom and online Connect Lab/Clinical/Classroom Tim J. Bristol, RN, PhD, CNE 3

12 Realistic in Class Questions? ntrack Knowledge Management tools Tim J. Bristol, RN, PhD, CNE 4

13 Back to Basics Learning Activities NCLEX Test Plan Tim Bristol, RN, PhD, CNE Walden University Ext. 1 Activities based on Safe and Effective Care Environment Management of Care Safety and Infection Control Health Promotion and Maintenance Psychosocial Integrity Physiological Integrity Basic Care and Comfort Pharmacological and Parenteral Therapies Reduction of Risk Potential Physiological Adaptation Management of Care Delegation Debate Teams of 6; each team chooses 3 nursing interventions/tasks; Half the team argues for delegating the 3 tasks; Half the team argues against delegating. Teams post their final findings in an online discussion for further review. Can get as formal as you like (ie. Opening argument, counter, closing, etc. AND professional references to include BON/BNE position statements); May want to assign the interventions/tasks to avoid a lot of replication. See Appendix D Safety and Infection Control Create a Crossword In small groups students come up with a list of clues/words that demonstrate the effects of sensory deficits on client safety. Clients can be in the home, hospital, long- term care, or even community settings. Then the groups create a crossword puzzle and share with the other teams. The faculty chooses a couple of clue term combos to 'include' on the next exam. Health Promotion and Maintenance Post-Op Pain Concept Map Given your assigned developmental group, create a concept map for that client based on them experiencing severe post operative abdominal pain not well controlled with medication. Focus on the impact the pain could have on their normal functioning and what non pharmacological interventions may be utilized. Develop the concept map with the online Concept Map Generator. Upload the Concept Map PDF to the Developmental Discussion forum. Then comment on two other maps. Psychosocial Integrity Explore NAMI Discussions Sign up for free access to the parents' section of NAMI. Do not participate in the NAMI discussions. Do not reply or post. Review some of the discussions. Report back to the class what you have discovered. Would you send a client's family here? Why or why not? Tim J. Bristol, RN, PhD, CNE 1

14 Basic Care and Comfort Chat Challenge Your reading for today included changing the colostomy wafer and pouch. This includes specific assessments to ensure the client is not at risk for infection/breakdown/embarrassment In your groups ( assign them in groups of 5) go into the chat area in Blackboard and list the steps in changing the wafer of a colostomy. One person lists one step, then one person the next and so on. Each step must be posted from a different person. Once you feel your group has completed this, raise your hand. I will check the list. The first team with a complete list wins a trip to Tim's treasure chest. Pharmacological and Parenteral Therapies Sharing Experiences Invite 3 individuals (friends, family, former patients) to share their experiences with medication therapeutic/side effects. Can be a recorded video or live in class. HTN medication;anti-depressants/psychotics;hormone Replacement In 5 minutes, please introduce yourself and then answer these questions: What prompted you to begin this medication? What were the most significant 3 effects this medication has had on you? How has your life changed with this medication. Student activity: Create a Power Point Patient Education Piece on managing the medication discussed. Each student/group is assigned one of the meds from that person. Be sure to get a signed release for Audio/Video capture/ distribution from those who share. Reduction of Risk Potential At Risk Rescue - Wiki Student Groups are assigned an At Risk Situation At risk for aspiration At risk for skin breakdown At risk for infection At risk for altered perfusion At risk for impaired oxygenation The Wiki will include a description for 3 different clients that would fit into that category. For each client they must describe: Key risk factors Key symptoms or changes that help identify manifestations of that risk Key nursing actions to prevent this risk Key nursing actions to reverse injury related to their scenario Because this is a Wiki, students can be as creative as they like. They can add images, video, power point, text, color, etc. If a Wiki is not available. They can create a free Blog or facebook group. Physiological Adaptation Living Lecture Today we will be working on the Respiratory system. Follow along online as I lecture. p// / / p / p Note the interactions and audio. Please turn the audio off so you hear me live. You can listen to the recordings later. Concept Map Creator Free with Text Book Free and Open/Available: FA Davis: IHMC TECH TOOLS Tim J. Bristol, RN, PhD, CNE 2

15 Musical Map Collaboration 1. Each Poster Has a Concept at the top. Your group moves to one of the posters. 2. Music starts, your group writes concepts on postits. Post on the posterboard no links yet. Try not to duplicate Concepts/ Subconcepts. 3. Music stops you stop writing and move to next poster. 4. Music Starts. Start writing. 5. After group gets to 4 th board. Create links/crosslinks. facebook and Video Keep groups secret Don t friend students Keep your profiles private HIPAA is still HIPAA Twitter Can keep Tweets private Can block followers Chat in Blackboard Login see Appendix C Try to keep chats to 10 people if possible Knowledge Management KM+C=Real Life Practice in class Collaborate Tim J. Bristol, RN, PhD, CNE 3

16 QSEN-Reduce Reliance on Memory Highlights search Search your textbook or entire library Connect & Collaborate Make notes and share them with your colleagues and students AACN Essentials: telecommunication for effective communication Connect & Collaborate Notes appear in textbook Connect & Collaborate Highlighting is easy Connect & Collaborate Connect & Collaborate Use messages, notes, and file uploads to collaborate Integrated quizzes are graded and add accountability Define multiple groups to organize your efforts Tim J. Bristol, RN, PhD, CNE 4

17 Questions? Tim J. Bristol, RN, PhD, CNE 5

18 Higher Order Thinking Learning Activity Form A tool for developing Higher Order Thinking Learning Activities based on the NCLEX Test Plan Circle one in Each Area Client Needs* Integrated Processes* Clinical Reasoning/Complex Relationships CR 2 1.Safe and Effective Care Environment a.management of Care b.safety and Infection Control 2.Health Promotion and Maintenance 3.Psychosocial Integrity 4.Physiological Integrity a.basic Care and Comfort b.pharmacological and Parenteral Therapies c.reduction of Risk Potential d.physiological Adaptation 1.Nursing Process 2.Caring 3.Communication and Documentation 4.Teaching/Learning *Varied sources of data *Similar options *Prioritization *Teaching Notes: Environment Purpose Summary Tools Budget/Concerns **R VARK / Realistic, Visual, Aural, Read/Write, Kinesthetic Input Process Output Reflection on Learning/Thinking *NCSBN.org ; 2010 NCLEX RN Detailed Test Plan / ** VARK Adapted from Neil Fleming learn.com Copyright 2010, NurseTim, Inc. All Rights Reserved

19 Higher Order Thinking Learning Activity Form A tool for developing Higher Order Thinking Learning Activities based on the NCLEX Test Plan Circle one in Each Area Client Needs* Integrated Processes* Clinical Reasoning/Complex Relationships CR 2 1.Safe and Effective Care Environment a.management of Care b.safety and Infection Control 2.Health Promotion and Maintenance 3.Psychosocial Integrity 4.Physiological Integrity a.basic Care and Comfort b.pharmacological and Parenteral Therapies c.reduction of Risk Potential d.physiological Adaptation 1.Nursing Process 2.Caring 3.Communication and Documentation 4.Teaching/Learning *Varied sources of data *Similar options *Prioritization *Teaching Notes: Environment Purpose Summary Tools Budget/Concerns **R VARK / Realistic, Visual, Aural, Read/Write, Kinesthetic Input Process Output Reflection on Learning/Thinking *NCSBN.org ; 2010 NCLEX RN Detailed Test Plan / ** VARK Adapted from Neil Fleming learn.com Copyright 2010, NurseTim, Inc. All Rights Reserved