July 29, 2016

Dr. John ScarbroughAssoc Dean

School of Nursing

Welcome!

School Location ADN BSN

UNM Albuquerque X

CNM Albuquerque X X

CNM-RR Rio Rancho X X

NMJC Hobbs X X

SJC Farmington X X

NMSU Las Cruces X

NMSU-A Alamogordo X

NMSU-G Grants X

SFCC Santa Fe X X

CCC Clovis X

WNMU Silver City X X

UNM-T Taos X Fall 2016 X Fall 2016

8 Schools/Programs 11 locations 8 offer ADN 11 offer BSN

School Location NMNEC Prereqs ADN/BSN

UNM-G Gallup Fall 2016 Fall 2017

Luna CC Las Vegas Fall 2016 Fall 2017

UNM-V Los Lunas Spr 2018 Fall 2018

ENMU-R Roswell Fall 2017 Fall 2018

NNMC Española Fall 2015 Fall 2018

NMSU-C Carlsbad Fall 2018 Fall 2019

Doña Ana CC Las Cruces Fall 2014 Consider after

Fall 2020

7 Schools/Programs

8:30 – 8:50 Leadership Council Updates

8:50 – 9:00 NMCNE Update

9:00 – 10:00 Dr. Marcy Stoll – “Changes w ACEN”

10:15 – 11:30 L3 “Care of Pts w Chronic Conditions”

11:30 – 1:00 Working LunchQ&A with Dr. Stoll OR ADN Capstone

1:00 – 3:00 Workshop: “How to Link Classroom Concepts to the Clinical Setting”

3:00 Evaluation and CEs

Reimbursement for

Mileage and Lodging*

Forms will be emailed on Monday

◦ *Refer to reverse side of agenda

5.50 FREE CEs thank you NMBON and APIN

1. Sign in for CEs at registration table

2. Attend FOUR sessions 9:00 “Changes with ACEN” 10:15 “NMNEC L3 Care of Pts w Chron Condt” 11:30 “Q&A w Dr. Stoll” OR “AND Capstone” 1:00 “How to Link Classrm Cncpts to Clinical Sttng”

3. Complete evaluation at 3:00

4. Turn in eval to registration table

5. Receive your CE Certificate (no partial CEs)

Learning Outcomes: 9am Dr. Marcy Stoll “Updates and Changes of

ACEN Standards and Criteria” The learner will gain an understanding of the recommended new standards and criteria pertaining to ACEN accreditation so they may build a process to be in compliance now, and into the future.

10:15 Session “NMNEC Level 3 Care of Patients with Chronic Conditions” The learner will, through examples of specific classroom set up, specific teaching strategies, and specific lessons learned, (specifically in the clinical setting) utilize the didactic and clinical concepts and exemplars specific to this course in the NMNEC curriculum.

Learning Outcomes: 11:30 Breakout Working Lunch Sessions ◦ “Q&A with Dr. Marsal Stoll” The learner will gain specific

insight into the recommended new standards and criteria pertaining to their specific ACEN accreditation to manage the process to be in compliance now, and into the future.

◦ “ADN Capstone” The learner will formulate recommendations for this course and specifically determine if standardization is necessary, as well as, determine a plan to move forward.

1pm Workshop “How to Link Classroom Concepts to the Clinical Setting” The learner will gain knowledge and experience in how to link classroom concepts to the clinical setting. They will learn how a concept informs an exemplar, specifically addressing the concept of metabolism/diabetes and how it is addressed in the clinical setting.

Approval Statement

This continuing nursing education activity was approved by New Mexico Nurses Association Accredited Approver Unit, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Conflicts of Interest:

Planners & Presenters of this CNE activity have no conflicts of interest

The following commercial entities are providing support:

None

The following governmental or non-profit entities are providing sponsorship support:

NMNEC grant funds:

New Mexico Board of Nursing NMNEC grant

Robert Wood Johnson Foundation APIN grant

Nisa Bruce, MS, BSN, RN, BASan Juan College

Diane Evans-Prior, MSN, RNCentral New Mexico Community College

Jenny Landen, MSN, RN, FNP-BCSanta Fe Community College

Judy Liesveld, PhD, PPCNP-BC, RN University of New Mexico

Terry Keller, PhD, RN, MPANew Mexico State University

Delores Thompson, MSN, RN, CNE, FNPNew Mexico Junior College

John Scarbrough, PhD, PT, RN, CNEWestern New Mexico University

Tricia Maule, MSN, RNSan Juan Regional Medical Center

Julia Vasquez, MSN, RNChristus St Vincent Regional Medical Center

Updates

How many first time attendees

do we have?

Have questions?

◦ See a Leadership Council member today

• Past Funding• FY9-10 $53,314 (Ridenour)

• FY10-11 $70,265 (BON)

• FY11-12 $128,624 (BON)

• FY12-13 $129,929 (BON) & $150,000 (APIN)

• FY13-14 $154,755 (BON) & $150,000 (APIN) & $15,000 (HED)

• FY14-15 $158,771 (BON) & $150,000 (APIN)

• FY15-16 $197,359 (BON) & $150,000 (APIN)

• Current Funding• FY 16-17 NMBON $74,000

• APIN extension (thru Nov 30) $72,000• Staff

• Becky .50• Mary .40• Admin .25• Graduate Assistant .25

Aug 11 Meeting – NMNEC Leadership

Statewide Meetings:

• July 29 (free CEs) – APIN funds

• Nov 4 (free CEs) - APIN funds

• February (free CEs) – BON funds

• Limited travel reimbursement

• Limited catering

• July & November ?

Leadership Meetings:

• No travel reimbursement

• Lunch

Website - $0

Office Supplies - $100qrtr

Printing - $250yr

Consulting - $0

Educator’s Conference - $0

What’s new with the Center for Nursing Excellence?

“Changes with ACEN”Updates on Standards and Criteria

Dr. Marcy Stoll, CEO

ADN and BSN handouts were emailed on Friday/Wednesday

NEXT: “L3 – Care of Patients with Chronic Conditions”

“Care of Patientswith

Chronic Conditions”Beverly Romero, SFCCLouise Cisneros, CNM

Clinical Course set up

Teaching and learning strategies in clinical

What works, what hasn’t

Challenges◦ Skills Intensive

◦ Clinically Intensive

◦ Graded on A, B, C scale, not pass/fail

Solutions◦ Front loading skills content

◦ Shared calendar

◦ Grading

◦ Rubrics

◦ Care plan swapping

◦ Weekly reporting

Methods of Evaluation and Grade Determination

Assignment Frequency Points per Assignment

Total PointsPossible

Graded careplans

1 each week10 100

Skills Testing During first two weeks

5 per skill 20

Simulation 6 sims over term 5 30

Nursing Article Once 10 10

Clinical Evaluation

Once at end of term

176 176

Total: 336

See handouts

Conceptually based

Allows for customization for patient care

Rubrics

Documentation of data Concept mapping – showing relationships Ease of readability Integration of client Nursing diagnosis Goals and outcomes Implementation Evaluation Evidence Potential complications

See handouts Conceptually based Higher quality nurse thinking (streamlined –

quality over quantity) Easier to see big picture (and to evaluate if

the student can see the big picture) Rubrics

Documentation

Showing relationships

Integration of client

Nursing diagnosis

Potential Complications

Medication completion

Careplan swapping

Weekly reporting

“Care of Patientswith

Chronic Conditions”Beverly Romero, SFCCLouise Cisneros, CNM

1. How this clinical course is set up

2. Teaching/Learning strategies used in the clinical setting

3. What has worked and what hasn’t

Concepts

Exemplars

Skills

Simulations

Hand out #1- Comprehensive Calendar

1st week of class Math Exam

Certifications

Fingerprinting

1st skill- Venipuncture (Safety)

Weeks 2-3

Skills: ◦ IV Medication administration (Safety)

◦ Urinary Catheter Care and Insertion (Elimination)

Week #3

First clinical

Hand out #2- Clinical Partner Information Sheet

Teach one week

Check off the next week

Open Lab for Practice

Venipuncture

IV Administration

Urinary Catheter Insertion and Care

Surgical Wound and Central Line Dressing

Blood Administration & PICC Line Blood Draw

Airway Suctioning and Trach Care

Dysrhythmias

Chest Tubes

Metabolic Regulation

Gas Exchange

6 Students at a time for 1 hour experiences

Skill Reinforcement

Level 1 skills

Due twice a semester

Clinical AssignmentHandout #3-6 SimChart/Clinical Floor Assignment

DURING CLINICAL DAY

◦ Patient Charting

◦ Conceptual Patient Care Assignment

◦ Medication sheet

◦ Charge Nurse Report

Post Clinical AssignmentSimChart Assignment

Diagnosis-Incorporating Primary and Interrelated

concepts and exemplars.

Lab Tests- Correlate with primary concept and

exemplar

Care Plan- Reflecting Primary and Interrelated concept and exemplar.

Handout #7-Critical Thinking Exercise

Pullouts

Clinical instructors take part in the didactic, skill and clinical components of the course.◦ Assists with reinforcing concepts and exemplars

◦ Students can learn from different instructors

◦ Team Oriented

Students have had Pharmacology

Skills◦ Lower Level Skills

◦ Front Loading

Clinical◦ Health Assessment in Level II

Dysrhythmias ◦ Higher level skill

1. BOXED LUNCH

2. “Q&A with Dr. Marcy Stoll”

OR

“ADN Capstone”

“How to Link Classroom Concepts to the

Clinical Setting”

Sue Koronkiewicz, UNMNancy Morton, UNM

Deborah Minke, UNMH

Change in healthcare

◦ Traditional clinical education hasn’t changed

Lack of /competition for clinical sites

Clinical opportunities not matching learning goals

Evidence

◦ Traditional clinical education models not accomplishing all clinical education goals

Ironside, P., McNelis, P., & Ebright, P. (2014).

◦ Concept based learning activities fosters synthesis and promotes clinical reasoning

Nielson, A. (2016).

Faculty goals for students◦ Knowledge synthesis, patient centered care,

synthesis of clinical situation

Requiring◦ Complex problem solving, clinical reasoning in

changing situations

Faculty spend almost all their time◦ Task completion, time management

◦ Med knowledge, lab values

What students do:◦ Task completion: Tasks = Learning

ADLs

Medication administration

Skills when the instructor was available

Waiting for the instructor

What students didn’t do◦ Clinical reasoning

Experienced nurses do this while completing tasks

Students are completely focused on tasks

Accomplishes deep learning, synthesis of knowledge and experience

Using various concept based teaching strategies supports deep learning

Deliberate focus of CBLs on theory to practice synthesis and clinical judgment

Preconditions for optimal learning with CBLs◦ Positive learning environment

◦ Faculty expertise in concept

◦ Student engagement and preparation

◦ Patient selection that exemplifies concept

New curriculum

IOM call for reform

Growth of stronger clinical partnerships

Deliberate collaboration of level faculty

Simulations

New curriculum

Student engagement

Clinical faculty ◦ Not well connected/supported

Lack of consistency/expertise in concept-based teaching

Competition with tasks

Clinical staff buy in

Connecting to the curriculum◦ Formal orientation to the curriculum

◦ Strong relationship with course coordinator

◦ Inclusion in level meetings

Collaboration◦ Process for timely feedback

◦ Formative and Summative Evaluations

◦ Clinical Toolbox

Study one concept per day/week without other responsibilities

Collaborative learning – pairing students by patient or concept

Time with educator while learning

Educator questioning

Immediate connection of theory and practice – in preconference or discussion

Assign a concept per day◦ Close to when concept taught in class◦ High incidence on clinical site

Alternative ways to explore concept◦ Pre-conference – review concept definition, signs &

symptoms, labs, expected therapies before clinicals◦ Post-conference – each student discusses their patient’s

status RE: concept Have format to give structure, follow

◦ Patient rounds – each student presents to rest of clinical group

Assign a few/half the students to do CBLAs, rest to do traditional clinical

Tanner’s Clinical Judgment Model◦ Integrate pre/post clinical experience◦ Tanner, C. (2006)

Conceptual Care Map Assignment◦ Combines elements of a traditional care plan with

concept mapping◦ Includes students’ responses to Tanner’s

questions

Clinical Concept Application Assignment◦ Promotes conceptual integration of patient

exemplars

DEFINITION: The ability of the physiological mechanisms of the body to maintain fluid and electrolyte homeostasis .

LEARNING OBJECTIVES: The student will :

◦ Assess the ability of the child 's body to regulate and maintain fluid and electrolyte balance .

◦ Identify factors which influence the fluid and electrolyte balance/imbalance of the pediatric patient .

◦ Plan and implement nursing interventions which promote fluid and electrolyte balance.

◦ Evaluate the effectiveness of interventions by nurses and other health care providers aimed at promoting fluid and electrolyte homeostasis .

◦ This learning activity will assist you in achieving the following course objectives : (list relevant course objectives)

LEARNING ACTIVITIES:

◦ Assess pediatric patient for fluid and electrolyte status using an assessment tool.

◦ Presentation of patient during walking rounds.

EVALUATION :

◦ Assessment process and completion of assessment tool.

◦ Participation 1n rounds presentation .

◦ Integration of concept-related content into nursing process reports (written) and clinical practice.

REQUIRED READING:

(list references of choice)

Heims & Boyd (1990)

DEFINITION: Exchange of oxygen and carbon dioxide at the cellular level must be efficient to support life. This process also required transport of oxygen and carbon dioxide.

LEARNING OBJECTIVES:◦ Assess the functional integrity and efficiency of the cardiovascular and cardiopulmonary

system.◦ Plan and implement nursing measures which promote effective and efficient oxygen and

carbon dioxide exchange.◦ Evaluate the effectiveness of interventions utilized to promote oxygen and carbon dioxide

exchange in terms of patient response.◦ This learning activity will assist you in achieving the following course objectives: (list relevant

course objectives)

LEARNING ACTIVITIES:◦ Clinical conference on oxygen and carbon dioxide exchange: Date: .◦ Observe a patient using the client evaluation tool (provided).◦ Complete the client evaluation tool through observation, client and/or parent contact, and

chart review.◦ Participate in walking rounds of patients evaluated for oxygen and carbon dioxide exchange.

EVALUATION:◦ Completion of the focused client evaluation tool.◦ Participation in rounds presentation.◦ Integration of concept related content in nursing process reports (written) and clinical

practice.

REQUIRED READING:◦ (list references of choice)

Heims & Boyd (1990)

Working with CBLA’s◦ Instructor/Staff/Student Buy-in

What Works?

Are We Noticing a Difference?

‣ Identify a clinical course and type of experience

‣ Identify a concept taught concurrently in a didactic class

‣ Plan an overall clinical course, incorporating some CBLAs

‣ Construct a CBLA

‣ All Tables Share

Heims, M.L., & Boyd, S.T. (1990). Concept based learning activities in clinical nursing education. Journal of Nursing Education, 29, 249-254.

Ironside, P., McNelis, P., & Ebright, P. (2014). Clinical education in nursing: Rethinking learning in practice settings. Nursing Outlook, 62, 185-191.

Nielson, A. (2016). Concept-based learning in clinical experiences: Bringing theory to clinical education for deep learning. Journal of Nursing Education. 2016; 55(7), 365-371.

Tanner, C. (2006). Thinking like nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education. 45(6), 204-211.

July 29, 2016

Dr. John ScarbroughAssoc Dean

School of Nursing