Evaluations of Teaching Strategies that Accomplish QSEN Competency Development

Transcription

1 Evaluations of Teaching Strategies that Accomplish QSEN Competency Development Kimberly Silver Dunker DNP, RN Karen Manning MSN, RN

2 Presence of the Nursing Faculty Shortage Nursing Faculty Vacancy Rates AACN-880 vacancies vacancies in BSN or graduate programs. NLN (2014) AACN (2015) Bittner (2017)

3 Barriers to recruitment and retention of nursing faculty Demographics Obstacles to attain of a Doctorate degree Salary Choosing the Educational Path Workload Vacancy Rates increase workload Additional tasks affect job satisfaction Student enrollment Retirement Decisions Job Satisfaction impact retirement decisions among faculty

4 How does competency increase satisfaction and retention? Does Competency play a role? What orientation and mentorship strategies do you have to build an empowering workforce to extend to all employees? What about Part-timers & Adjunct Faculty?

5 QSEN Competenies Patient/Family Centered Care Teamwork and Collaboration Safety Evidence-Based Practice Quality Improvement Informatics

6 Nurse of the Future

7 Nurse Educator Core Competencies (NLN) 1. Facilitate Learning 2. Facilitate Learner Development & Socialization 3. Use Assessment & Evaluation Strategies 4. Participate in curriculum Design and Evaluate Program Outcomes 5. Function as a Change Agent and Leader 6. Pursue Continue Quality Improvement in Nursing Educator 7. Engage in Scholarship 8. Function within the Education Environment

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9 RN Faculty Development Modules for Educator Competency Reflection of Novice Faculty How to Measure Clinical Competency Clinical Feedback Clinical Evaluation Safety with Medication Administration Stimulate Critical Thinking in Clinical Curriculum Design Cultural Competency in Nursing Education

10 Tools QSEN.org Academic Clinical Practice Taskforce 10

11 Reflections Orientation Challenges Advice

12 Orientation

13 Discussion Questions How do you prepare for your first clinical day? What does hospital orientation include? Where things are and what are the requirements for the clinical instructor. Do you need computer access? Does your students need computer access? How will you pick the patients in the clinical assignment? How early do you need to come to clinical? How late do you need to stay at clinical? How will your organize your clinical day and stay on tract? Do you create a to do list?

14 A DAY IN THE LIFE OF THE CLINICAL FACULTY MEMBER By: Sandy N. Cayo DNP, FNP-BC, APRN

15 Challenges

16 Discussion Questions Challenges What kinds of challenges occur while at clinical? How will you manage difficult situations? What resources do you have to manage challenging experiences, students, and clinical days? Student Injury- how to handle this

17 Advice

18 Discussion Questions Advice What surprised you about this vignette? What did you learn from this vignette?

19 Questions? 19

20 CURRICULUM DEVELOPMENT

21 Objectives Identify what elements of the syllabus are important in clinical. Describe how to prepare a student for an observation experience. Describe how to match clinical and theory course objectives.

22 The Syllabus is huge, what do I really need to know?

23 Objectives for Clinical What are the objectives for this clinical experience? What are the systems or disease I should focus on when choosing patients in clinical? What are the appropriate observations I can have my students do in clinical? What paperwork is required in clinical? How are the objectives linked to the summative clinical evaluation?

24 Floating a Student Video Vignette

25 Floating a Student What observations are appropriate during this clinical rotation? Where can I send the student that will meet the clinical objectives for this experience? Just because it is a fun place to go it doesn t really meet a clinical objective! Am I trying to thin out the clinical group by sending my students to unnecessary observations?

26 Observations Students are in observation mode, and should not be performing skills or tasks without a preceptor or clinical faculty present. Make sure the student is aware of the expectations while they are off your radar. Communicate with the unit, RN, or tech about the observation experience. Observations are not fair or equal experiences you cannot give every student the same experience don t put that pressure on yourself.

27 Observation Report Take time in post conference to have the student share about their observation experience Have the student write a report or journal about their experience. Be directive: What did they learn, or what surprised them about the experience.

28 Discussion Questions What elements make up a syllabus? What are outcome objectives? How are clinical experiences and objectives correlated? How are observation experiences related to clinical outcomes? When you float a student they are in observation mode. They should not do anything without the clinical instructor present. What assignments does the clinical instructor give to help enhance the observational experience? Who do you need to check with before sending a student off on observation? What communication must occur before the student goes to an observation? What should the clinical instructor tell the nurse who will be working with the student?

29 Stimulate Critical Thinking in Clinical Actively Conceptualizing, applying, analyzing, synthesizing, or evaluating information gathered by an observation, experience, reflection, or communication. Stimulates students in clinical Enhances the clinical experience Provides Education for Student learning

30 NOF Competencies Leadership Communication Professionalism Teamwork & Collaboration Informatics & Technology Safety Quality Improvement Evidence-Based Practice

31 QSEN Competencies Quality Improvement Evidence Based Care Communication Teamwork

32 NLN Core Competencies (2) Facilitate Learner Development & Socialization (4)Participate in Curriculum Design (6) Pursue Continuous Quality Improvement (8) Function within the Education Environment

33 Learning Objectives Describe what critical thinking is. Utilize methods for critical thinking in clinical. Understand how critical thinking improves the quality of patient care. Demonstrate how critical thinking improves safety of patients in the hospital.

34 Can you evaluate students critical thinking in clinical? How does the student develop answers to problems? What does the student do when he or she doesn t know the answer? Does the student cite reasons and sources? Does the student ask for reasons? Ask Why? Does the student seek information in making decisions? Does the student generate many alternatives before choosing a solution? Does the student recognize discrepancies in the environment?

35 Can Critical Thinking Be Taught? Thinking actively and thinking for ourselves is most important!

36 What situation requires critical thinking? ü Exploring the situation or issue carefully ü Discussing ideas in an organized way ü Supporting ideas with evidence and reasons ü Demonstrating openness to new ideas and different viewpoints ü Challenging assumptions that for the basis for ideas, plans, clinical approaches ü Imagining and exploring alternatives ü Utilizing logical reasoning skills ü Asking and answering questions

37 Approaches to develop critical thinking skills Standardized Labs and Diagnostics Nursing process Nursing care plans Clinical pathways Concept maps

38 Skills Lab Evidence Based Practice skills Teach them the right way The right way is not always your way Skills taught in correct order; according to the curriculum. Central line care, chest tube care, IV skills. Objective for clinical Practice and check offs

39 Communication SBAR S Situation Nursing Rounds On coming report Off going report CUS C I m concerned U I m Uncomfortable S Safety Describe the situation WHAT IS GOING ON NOW B Background Deliver a concise history WHAT HAS HAPPENED A Assessment Use your best Judgment WHAT DO YOU THINK IS WRONG R Recommendations WHAT WOULD YOU SUGGEST HAPPEN What needs to happen?

40 SBAR-Communication Video Vignette

41 Case Sets Disease of the Day Curriculum & Clinical Nursing Process Focused Assessment Diagnosis Planning Implementation Evaluation

42 Simulation. D s Direction Debriefing Discussion Danger Disaster

43 Post Conferences Evidence Base Practice Articles Recent Practice Hot Topics QSEN Curriculum focused Observation experiences Medication or near miss experiences Environment should be non punitive and non judgmental. What happens in Clinical Stays in Clinical

44 What happens in clinical stays in clinical Encourage students to discuss how they feel at clinical. I felt confident when I. I felt surprised when I I knew this before I came today. I performed a brand new skill today. Here is something I learned today This is how it felt today..

45 Questions Questions Encourage your students to ask questions Challenge the students with questions that can stimulate critical thinking Most important do this in a positive not a threatening way.

46 DISCUSSION QUESTIONS!

47 Discussion Questions What are some strategies you can use to stimulate critical thinking during clinical? How can you utilize pre and post conferences as a way to increase critical thinking for students? What benefit would it be to have students perform SBAR while in clinical? What is the clinical paperwork assigned to your students each week? What ways does the clinical paperwork enhance critical thinking for your students? How can you prepare your students to prioritize the patients care during clinical? What are some examples to provide verbal and written feedback on clinical paperwork for your students? What time manner should feedback be given to students while in clinical? What is situational awareness and how can critical thinking help students become more aware of their patients situation?

48 How Faculty Measure Clinical Competency

49 Objectives Identify methods for measuring competency in clinical education. Describe methods for measuring competency in clinical education.

50 NOF Competencies Patient-Centered Care Leadership Communication Professionalism Teamwork & Collaboration Safety Quality Improvement Evidence-Based Practice

51 QSEN Competencies Quality Improvement Evidence Based Care Patient-Centered Care

52 NLN Core Competencies Assessment and Evaluation Strategies (3)

53 Case Studies Use case studies to facilitate critical thinking. On the Fly Post conference Highlight one case study Use the patients that you have Highlight important information Highlight differences and comparisons from their book

54 Concept Mapping What is the benefit? How do you grade this? Is there a grading rubric? What are the most important aspects? ASK your lead instructor what is acceptable or unacceptable? ASK your lead instructor how to give appropriate feedback THIS IS DIFFICULT SO ASK QUESTIONS!!!

55 Plan of Care Map Medical DX: Nursing Diagnosis (NANDA ) Outcome with expected responses CO DX: Interventions Therapies Independent: Assessment/monitoring: Physical examination Teaching: Medications Collaborative: Laboratory data: Health promotion: Delegated: Illness prevention/management: Diagnostic tests: Evaluation: Sources:

56 Name: Date: Department of Nursing Medical/Surgical Nursing III Critical Thinking Assessment Evaluation Tool Grading Rubric Evaluation Criteria 1. Patient Information (Students fill out completely their patient information, not leaving any blanks) 2. Medication Administration: Filled out with complete order, class, reason for medication, parameters, IV administration if applicable. 3. Nursing Diagnosis: Selects highest priority nursing diagnosis for patient condition. 4. Identifies and Unitizes teaching for their patient. 5. Correctly identifies appropriate treatment interventions for their patient s priority nursing diagnosis. 6. Selects appropriate labs & diagnostic criteria for their patient s priority nursing diagnosis. 7. Identifies medications pertaining to their patients priority nursing diagnosis. 8. Gives focused assessment data for their patients priority nursing diagnosis. 9. Identifies measurable outcomes for their patients and evaluates how their patients responds to these outcomes. 10. Hands in their critical thinking assessment on time as outlined by their clinical professor. Instructor Feedback: Unsatisfactory Satisfactory Student Goals for Improvement:

57 DISCUSSION QUESTIONS!

58 Discussion Questions What are the ways you are measuring competency in your nursing students? How can the skills lab be used to promote and evaluate clinical competency for the nursing students? Do you use peer evaluation while in clinical? Do you expect your nursing students to work together as a team? How do you effetely use post conference to teach your nursing students? If you want your students to present a case or situation during post conference how do you prepare them to be effective? How do you teach your students to do concept mapping and clinical paperwork? Students should not leave clinical until they know exactly what their priorities are in their paperwork.

59 Safety with Medication Administration with Students in Clinical

60 QSEN Competencies Quality Safety Informatics Patient Centered Care

61 NOF Competencies Patient-Centered Care Communication Professionalism Systems-Based Practice Teamwork & Collaboration Informatics & Technology Safety Quality Improvement

62 NLN Core Competencies (1) Facilitate Learning (4)Participate in Curriculum Design

63 Objectives Attain information on how to safely administer medications during clinical Describe methods for safe medication administration. Perform safe medication administration pass. Create new ways to enhance the medication administration pass.

64 Medication Administration

65 Know the Rules Hospital has rules to keep the patient safe Must know what the rules are for your institution Know your students skill level Know your curriculum

66 Patient Medication Time Dose Route Assessment Situation Vital Signs Documentation Allergies RIGHTS OF MEDICATION ADMINISTRATION

67 QSEN Focused 2 patient identifiers and checks Arm bands Medication Reconciliation Standardized Medications Identify Work-arounds Time Outs

68 Be specific Side Effects Adverse reactions Nursing Considerations

69 Calculations IV rates IV push IV piggy backs PO tablet and liquid administration SQ administration Insulin administration IM administration

70 Ready Set Go How do I manage giving medications with my students in clinical?

71 Assign the task Assign your students to give medications. Communicate this with the RN/primary nurse. Set the expectations: You will be giving meds at 8, 10, & 12pm. Give clear and specific instructions to the students on your expectations.

72 What about my other students? How do I challenge those who aren t giving medications?

73 Don t forget about the others Quiz each other Discuss reasons for medications Observe RN administering medications. Potential Errors Near Misses Work arounds Difficulty obtaining medications from the pyxis or from pharmacy

74 Be Creative Seek out experiences that students can observe Hanging blood, platelets, FFP, Albumin Hanging TPN Chemotherapy IVIG Giving IV push medications

75 Time Out If a student is not prepared to give medications what do I do? Time Out Revisit student Decrease anxiety

76 Always Remember Safety First!!! Keep the patients safe. Communicate with the primary RN Set clear expectations for your students Find ways to decrease their anxiety they will learn more if they are not so anxious.

77 Discussion Questions

78 Discussion Questions What are the hospital rules about giving medications with students while at clinical? What are the expectations of your nursing school about medication administration in clinical? Do you tell your students what they need to know about their medications when they are preparing for a medication pass? What are the clinical faculty expectations? How do you manage the medication pass in clinical? How do you stay on time? How do you stay organized? What do you do for the students who do not get the opportunity to pass medications on a clinical day? What are some ideas or strategies to help those students learn their patient s medications? What strategies do you have for students who are not prepared to give medications or are anxious when giving medications?

79 Feedback & Formative Evaluation

80 Objectives Analyze the difference between a star, average, and poor performing nursing student. Describe how to evaluate a star, average, and poor nursing student. Understand when to give a clinical warning to a poor performing nursing student.

81 QSEN Competencies Quality Improvement Safety

82 NOF Competencies Leadership Communication Professionalism Teamwork & Collaboration Safety Quality Improvement

83 NLN Core Competencies (1) Facilitate Learning (2) Facilitate Learner Development & Socialization (3) Assessment and Evaluation

84 Clinical Evaluation One of the most challenging responsibilities of nursing faculty is to evaluate student clinical performance (Boley & Whiney, 2003) Because: Ø Some nursing educators have not been formally prepared in the evaluation process. Ø Some educators fear that evaluation makes them vulnerable to legal action.

85 Peer & Self Evaluation Formative evaluation Students should perform self-evaluation weekly. Journaling Clinical evaluation Peer Evaluation Encourage clinical group to work together as a team and provide each other with constructive criticism. critique each other in a non threatening way.

86 Clinical Evaluation Strategies Start Student Average Student Poor Student

87 Motivating Performance Praising Providing Corrective Feedback Preventing Unsafe Practice Student does not seek appropriate backup or assistance Student enters clinical area more anxious Student arrives late Student approaches patients in an uncertain manner Student does not know when care is complete Student cannot recognize gaps in care Students had difficult setting priorities Students had difficult organizing patient activates Students does not recognize errors

88 Star Students Motivated Energetic Engaged Critical Thinkers Determined Disciplined Questions

89 Star Student Take 1

90 Start Student Take 2

91 Star Students Need to reach higher

92 Average Student Meeting the clinical objectives Non participatory Difficult to motivate at times Safe in clinical Not on the radar

93 Average Student Take 1

94 Average Student Take 2

95 Average Students Need to reach higher

96 Poor Student Not meeting clinical objectives Lacks motivation Anxious in clinical Unaware of performance Not prepared Unsafe

97 Poor Student Clinical Warning

98 How to manage a failing student Communicate with the course leader Address occurrences as they happen Don t wait Make expectation clear, firm, and focused Keep feedback consistent between students Document Document Document

99 Discussion Questions

100 Discussion Questions How can you motivate your students? What are the qualities in a star or average nursing student? How do you identify your poor nursing students? How do you manage a student who is not meeting the clinical objectives? What does it mean to give formative feedback to students?

101 Summative Clinical Evaluation & Anecdotal Notes

102 Objectives Identify what elements of the syllabus are important in clinical. Describe how to prepare a student for an observation experience. Describe how to match clinical and theory course objectives.

103 QSEN Competencies Patient Centered Care Quality Improvement Evidence Based Practice

104 NOF Competencies Patient-Centered Care Leadership Communication Professionalism Safety Quality Improvement Evidence-Based Practice

105 NLN Core Competencies (1) Facilitate Learning (2) Facilitate Learner Development & Socialization (3) Assessment and Evaluation

106 Objectives Discuss ways to provide fair assessment in the clinical setting Identify appropriate methods for making assessments in the clinical setting. Discuss what are the best strategies for anecdotal note taking. Identify common errors made when completing a clinical evaluation

107 Let s start with students Your Job: Provide opportunities for application of knowledge, critical thinking, accountability, professional role development, etc. How well do they do it? That s a judgment call That s right, subjectivity. Can you live with it?

108 Lets take another look at the word Judgment Based on our opinion Our opinion is based on our values and experience Process is to: Make observations Evaluate degree of correctness Determine good or poor performance

109 But, isn t this a bad thing? Must be based on a system of fairness? We all think we are fair. Do our students think we are fair? Do our colleagues think we are fair? Reconsider your level of fairness.

110 OK, so maybe I m not always completely fair. What do I do about it? Examine: What are your values? What are your attitudes? What are your beliefs? Then: Use the objectives. Be Supportive

111 What type of evaluation are you doing? Norm referenced? What if everyone is on the low end of the spectrum? Criterion referenced? Now you ve got some legal standing. Clinical evaluation tools are criterion-referenced measurements because the student being evaluated is required to meet pre-established criteria to pass and progress in the program (Oermann & Gaberson, 1998) Formative? Feedback, feedback, feedback Summative? Based on your criteria

112 Evaluation and Communication

113 Of course I give feedback But do you? Make it specific? Give appropriate verbal and nonverbal feedback? Give timely feedback? Adapt your feedback to student s level of need? Provide guidance with it? Set acceptable limits, time frames, etc.? Most importantly Do you document it?!!!

114 You mentioned objective can we review the concept when applied to clinical? May be based on course objectives. May be based on your clinical area. Must provide guidance for the behaviors that are desired. These behaviors should include cognitive, affective, and psychomotor. Often state the broad objective then state desired behaviors under each objective. Desired behaviors are usually broad in nature for clinical evaluation.

115 Make Observations Anecdotal Notes Student Name: Date: Patient Information Professional Issues Practice Issues Anecdotal notes: Time and date Behavior Your interpretation Student s interpretation Suggestions for improvement Checklists Delineate each step in order Add in frequently seen errors Include time frame if appropriate

116 Then, you evaluate them Look at each objective carefully Keep in mind if this is formative or summative evaluation. What is the most appropriate method of evaluation? Observation (formal and informal) Anecdotal notes and checklists Written (care plans, case studies, process recordings, journals, term papers) Presentations Simulations Portfolios (students best work or growth process)

117 Summative Evaluation

118 DOCUMENT, DOCUMENT, DOCUMENT

119 Document Performance Deficits YOU ARE NOT ALONE! Removing a student from a clinical area Disciplining a student Failing a student Help students to be successful and understand that you are here to help them. That you do care despite their behavior.

120 Then Assign a Grade Letters Numbers Quality Values Frequency of Demonstration General Terms

121 Are you a or a real Leniency errors Severity errors Central tendency errors Halo effects Personal biases Logical errors

122 Discussion Questions

123 Discussion Questions What type of evaluations do you perform on your students? How can you make your feedback specific, timely, and objective? How do course objectives help to keep your clinical feedback unbiased? How can you document your observations of your students clinical performance?

124 THANK YOU FOR YOUR TIME!