Susan A. Boyer, RN, M.Ed. Executive Director Vermont Nurses In Partnership, Inc

Susan A. Boyer, RN, M.Ed.Executive Director

Vermont Nurses In Partnership, Inc

Objectives: Discuss professional practice

expectations & changes in healthcareAcknowledge barriers to role

preparation Consensus on definition of ‘competent’Consider collaborative support systems

for effective transition into practice

MicrowavesVelcroATMs

Faster, easier way of doing something

Did not exist 30 years ago!

A single internship framework used across continuum of care

Multiple sites using the same competence assessment tool

Standardized preceptor education with same teaching plan statewide

Work from a networking model, rather than traditional business framework

How has healthcare changed?

Proactive vs. reactive response

How has healthcare changed?

Pair and share your answers to this question – jot down the results

Work expectations Changes in technology, medications

& information management

Acuity and intensity of patient care

Timeframe of the patient stayAccess to healthcare information

Web-based resources

Expectations of patients

Competence Expectations License equals competence?

Expected length of employment at agency

Use of traveling nurses to staffQualifications of students coming into

collegeVolume of instruction that is needed

Clinical instruction – settings and who to teach

Use of simulation and PDAs

Are nurses taught the same content as 30 or more years ago?

Are they taught in the same manner?

© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No copying without permission. [email protected]

DevelopmentEntry into practiceOngoing competence validation

Objectives:

Acknowledge the barriers to role preparation

Knowledge

Comprehension

Application

Analyze

Synthesize

Evaluate

© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. [email protected]

Academic Education - Foundation built in classroom

Affective Attitude/feelings•Internalize values•adopt behavior •Organize personal value system•Value-understand & act•Respond or react to•Receive (be aware)

PsychomotorTechnical skills•Naturalization•Integrate related skills •Become automatic•Articulation•Develop Precision•Manipulation (follow instructions)•Imitation or copy

Agency-based Education - Experiential Learning

A Simple Linear Model Some models suggest that problem

solving is a set of clearly defined and prescribed steps.

This is rarely the case.




Theoretical & Experiential Knowledge

Technical Skills

Critical Thinking Attitudes/

Behaviors - skills

Interpersonal Skills 2002 R. Alfaro-LeFevre

Continue the discussion: We’ve started identifying the gap

Now let’s consider how we bridge that gap – 2 minutes discussion

What has changed/needs to change from the way we did it when . . . .

Transition from care plans – linearTo concept mapping –

multidimensional Information becomes less important

than the ability to select and weigh it, to discriminate, and to evaluate competing knowledge claims.

http://servercc.oakton.edu/~mikey/nur104/guidelinesformapping.html





Definition: Concept maps offer a method to represent information visually. There are a variety of such maps.

Purpose: • Harness the power of our vision to understand complex information "at-a-glance." • The brain interprets incoming information to make meaning. • It is easier for the brain to make meaning when information is presented in visual formats. •Thus, a picture is worth a thousand words

Objectives:

Consensus on definition of ‘competent’

HOW?

What does competence look like?


Tools include: Orientation and/or performance appraisal Reflection of professional role or a

grocery list Minutia of practice

Tasks and procedures Concepts and critical thinking

Assessment, evaluation, planning

Responsibility for our practice & knowledge

Competency: The integration of knowledge, attitude, and skills needed to perform a specific job function.


The individual’s capacity to perform job functions – possession of knowledge, skills, and ability to function in a given field (Battle Creek Health Systems)

The effective application of knowledge and skill in the work setting. (del Bueno, 1990)

The ability to perform a task with desirable outcomes under the varied circumstances of the real world. (Benner, 1982)


Competence: An individual’s capacity to perform his of her job functions.

Competency: An individual’s ACTUAL performance in a particular situation.

Actual performance is the gold standard for demonstration of

competence


HR.3.10 – Assessing staffs’ ability to meet performance expectations

“the systematic collection of practitioner- specific data to determine an individual’s capability to perform up to defined expectations”


Job description – orientation – performance appraisal

Does your documentation tool: Define the expectations of the

role?Based on competency in

practice? Critical thinking component? Interpersonal issues?


Foundation - COPA model Essential Duties

Example of How do you know that the individual meets it?

Practice based, performance based

Start with an action verb KISS principle


1. Assessment and Intervention2. Communication3. Critical Thinking4. Human Caring and relationship skills5. Management Skills6. Leadership Skills7. Teaching Skills 8. Knowledge Integration Skills

Lenburg, Carrie B. The Framework, concepts and methods of the competency outcomes and performance assessment (COPA) model. © 1999 Online Journal of Issues in Nursing. Sept. 30, 1999 http://nursingworld.org/ojin/topic10/tpc10_2.htm© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No

copying without permission. [email protected]

http://nursingworld.org/ojin/topic10/tpc10_2.htm

Critical behaviors are the supporting structures of the competency assessment and are the essential behaviors that one must demonstrate to validate competency.

Initial and Ongoing assessment They must be measurable and specific.


What performance outcomes do you see in the workplace that give evidence of competence in selected core skill?

Action based statement – start sentence with an action verb

KISS principle


Demonstrates the ability to complete a full cardio-vascular system assessment

VS Assesses cardiovascular system Completes cardiovascular assessment. Determines effectiveness of

cardiovascular perfusion Identifies challenges to adequate

perfusion Anticipates CV perfusion problems

Time to observe care being provided To see if capable to perform clearly defined

expectations = Performance Outcomes Evidence collection Competency Verification Methods

Demonstration Verbalization Simulation


Instructional strategies•Test results •Policy Review•Case Study

Transforming nursing through reflective practice

Transforming nursing education though problem-based learning

Concept based vs. case based Focus on concepts within academia, within

internship, within preceptor developmentTechnology as a catalyst to

transforming nursing care - Bradley, C. Nursing Outlook Volume 51, Issue 3, Pages S14-S15

Patient care technology as a priority

Nurses’ involvement in technology

Reducing physical demands of care delivery

04/18/23 Susan A. Boyer, RN, M.Ed. VNIP, Inc 36

Preceptor development and support

Clinical Coaching Plan - Development of Critical Thinking

Preceptors

Interns

Clearly defined expectations Standardized performance outcomes (COPA)

Objectives:

Consider collaborative support systems for effective transition into practice

Benner writes that nursing requires both Techne and Phronesis

Techne – explicit knowledge related to procedural or scientific knowledge

Phronesis – is more complex; it is reasoned practice that is developed through experiential learning, where the nurse is continually improving her or his practice

39

To think about how and why we should act in order to change things, for the best.

Gaining phronesis requires time, as one must gain both the habit and understanding of correct deliberation

Phronesis is reasoned practice, employed through experiential learning, where the nurse is continually improving their practice

40

To a culture of nurture and supportTeamworkRelationship-based carePreceptor supported orientationPreceptors prepared for role that

they facePreceptor support systems

Experienced practitioner who

provides transitional role support and

learning experiences to new staff.


CommunicationInterpersonal SkillsTeaching/Learning TheoryHow to provide experiential

learning while protecting safetyInstruction that is needed by

ALL direct care providers Let ‘s teach & learn as a multi-

disciplinary team


OrientationCompetency assessmentPreceptor program

Establish the timeframe Identify resources Time to teach


Preceptor use is collaborativeSchool and practice are inter-relatedLet’s build new systems of collaboration to

solve the challenges faced in today’s HCClinical instruction – preceptingJoint appointments or contracted servicesOffer courses to serve development and

clinical instruction as recognition/reward

Any fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.

- Albert Einstein


Technology as a catalyst to transforming nursing care Bradley, C. Nursing Outlook, Volume 51, Issue 3, Pages S14-S15

Alfaro-LeFevre, R. Critical Thinking Indicators- Evidenced based version http://www.alfaroteachsmart.com/2008CTI.pdf . Accessed on February 21, 2008.

Gaffney, T. Regulation of Nursing Practice From the Nursing Risk Management Series: Article 2 (Web site accessed on February 21, 2008) http://nursingworld.org/mods/archive/mod310/cerm102.htm#Willoughby

Willoughby, C., Budreau, G., & Livingston, D. (1997). A framework for integrated quality improvement. Journal of Nursing Care Quality,--LI (3) 44


Documents

Susan A. Boyer, RN, M.Ed. Executive Director Vermont Nurses In Partnership, Inc