505 finalproject

8/12/2019 505 FinalProject

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Clinical Competencies Program Evaluation

Tara Peters

Boise State University


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Summary

Mountainland Applied Technology College (MATC) Practical ursing program conducted anevaluation o! their clinical competency program" #hich is one aspect o! the nursing program$ Thesurvey results !ound that the clinical competency program is generally e!!ective" though some speci!ic!indings #arrant !urther attention$ Students and instructors ali%e !ound the clinical competencies to &ee!!ective in providing structure and direction to students" demonstrating student progress and in

helping students meet program outcomes$ The program #ill continue as it is in the near term" &ut #illundergo some revisions &ased on the evaluation !indings during 2'$ The target date !or rolling outthe revised clinical competencies is August" 2'$

Program Description

MATC*s Practical ursing (P) Program is t#o semesters in length and is comprised o! severalseparate &ut closely lin%ed elements each designed to address and speci!ic aspect o! the novicepractical nurse*s essential educations and training$ The clinical competencies program is one suchessential element designed to provide practical nursing students #ith a tool intended to help themdevelop their clinical s%ills" critical thin%ing s%ills" and to synthesi+e their didactic and clinicaleducation$ Thus" the clinical competency program #as designed to provide students #ith the

!oundations they #ill need to &e sa!e" competent nurses upon completion o! the P program$

Program Objectives

The clinical competencies program o&,ective is to provide P students the %no#ledge" s%illsand e-perience they need to !unction as novice nurses a!ter graduation$ By the end o! the t#o semesterPractical ursing program students should &e a&le to.

/emonstrate critical thin%ing in the use o! the nursing process

/emonstrate use o! management and leadership principles in the delivery o! patient care

Per!orm nursing interventions in a sa!e and e!!ective manner

Use therapeutic communication #hile providing nursing care to patients and their !amilies

/emonstrate pro!essional &ehaviors

Each o! these clinical competencies are !urther &ro%en do#n into speci!ic elements that detail #hatstudents need to do in order to !ul!ill the competencies" and the complete clinical competencies areincluded as an attachment !or re!erence$ Students are also sho#n ho# to complete s%ills such as nursesnotes" medication administration and sterile techni0ue" !or e-ample" during s%ills la& !or nine #ee%sprior to attending clinicals$ This is to help ensure that students possess the s%ills they need to &esuccess!ul at clinical and that they understand #hat #ill &e e-pected o! them$ Students are alsoe-pected to pass o!! on each s%ill prior to attending clinicals" and they #ill not &e allo#ed to attendclinicals until they can demonstrate &asic competency in each s%ill$

Program Components

Prior to attending clinicals all nursing students must attend several #ee%s o! la&s #here they#ill learn &asic nursing s%ills and &egin to apply #hat they have learned in their didactic classes totheir clinical practice$ 1nce students have completed the re0uisite num&er o! la&s and havedemonstrated &asic pro!iciency o! the learned s%ills they #ill move !rom la& to their clinicalplacements in one o! three longterm care !acilities$ Students attend clinicals once per #ee% at the samesite each #ee% !or the rest o! their !irst semester and they #ill #or% closely #ith a nurse #hile also&eing supervised &y their clinical instructor$ 3nstructors have eight students to monitor and assist" andthis is an average student to instructor ratio$

4hile in clinicals the students #ill &e e-pected to demonstrate their a&ility to per!ormpreviously learned s%ills and they #ill have the opportunity to develop their critical thin%ing s%ills &yapplying #hat they learn in their didactic classes to the clinical setting$ 3n order to %eep trac% o!


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student progress and to provide structure to the clinical e-perience" the !aculty has devised a set o!clinical competencies (attached) that the students must complete success!ully each semester$ Theclinical competencies #ere designed to allo# !or more assistance during the !irst semester and moreindependence and personal responsi&ility in the second semester #ith the goal o! providing support !ortheir learning early on and encouraging steady progression o! their s%ills" critical thin%ing andcon!idence &y the end o! the t#o semester program$

The clinical competencies (Appendi- A) are mapped to the P program*s Student 6earning1utcomes (Appendi- B) and 7SE 0uality measures (Appendi- C)$ Each o&,ective contains a num&ero! individual items the student must complete success!ully in order to meet the o&,ective and to &econsidered competent$ 3t is understood that students are ne# to nursing and possi&ly to the clinicalsetting8 there!ore" students are allo#ed multiple su&missions o! each element i! needed$ 4hile clinicalinstructors do e-pect to see progress as each semester un!olds" the #ee%ly clinical competencysu&missions are considered !ormative (no points attached) until the !inal due date at the end o! thesemester #hen they &ecome the summative evidence o! clinical success or !ailure$

The !aculty intends that every element o! the P program &e relevant and lin%ed to a speci!iclearning outcome or competency$ 3n addition" each class" la&" simulation" or clinical e-perience is notto &e considered a discreet unit &ut they are all lin%ed and &ased on the same curriculum$ Students

should &e a&le to move !rom didactic to la& to clinicals and %no# that voca&ulary such as o&,ective andsu&,ective data" s%ills such as nurse*s notes and physical assessments and so !orth are consistent$ Theclinical competency program is intended to lin% didactic to clinicals" to provide a consistent clinicale-perience !or students and to provide all students a consistent learning e-perience #here they candevelop their nursing s%ills and demonstrate their competence in %ey areas$

Evaluation Method

The evaluation !ollo#ed a goal&ased model" and 0uantitative and 0ualitative data #ascollected using surveys and intervie#s to ans#er the !ollo#ing 0uestions.

/o the clinical competencies help students use and demonstrate critical thin%ing in the use o!

the nursing process9

/o the clinical competencies help students use and demonstrate management and leadershipprinciples in the delivery o! patient care9

/o the clinical competencies help students use and demonstrate their a&ility to per!orm nursing

interventions in a sa!e and e!!ective manner9

/o the clinical competencies help students use and demonstrate their a&ility to use therapeutic

communication #hile providing nursing care to patients and their !amilies9

/o the clinical competencies help students use and demonstrate pro!essional &ehaviors9

/o the clinical competencies help students and instructors !ocus their e!!orts during clinicals9

/o students and instructors have enough time to complete the clinical competencies9

/o students and instructors have enough time to as% and ans#er 0uestions during clinical and

postclinical con!erences9 4ere students and instructors oriented to the clinical competency program and do they !eel they

understand e-pectations$

Are instructors recogni+ing student progression !rom one semester to the ne-t9

Are students a&le to integrate classroom learning into their patient care9

:inally" ursing Advisory Board mem&ers #ere as%ed a&out our students* and graduates* per!ormanceat clinicals" a!ter hire" or &oth i! applica&le$


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The surveys addressed the o&,ectives given earlier though the 0uestions #ere some#hatdi!!erent !or students than !or instructors$ The survey 0uestions #ith results are attached as Appendi-/$ The evaluation is aimed at e-amining the e!!iciency" e!!ectiveness and impact o! the clinicalcompetency program$ The program #ill &e considered success!ul i! it is easy to use" helps students andinstructors gauge student per!ormance in clinicals" and i! our community partners report positive

outcomes !or and perceptions o! our students a!ter graduation$ The results #ill &e used to in!orm the!aculty*s decisions a&out ad,ustments to the program at this time" though the program #ill &emonitored at least every semester or as needed to ensure student learning is ta%ing place and programgoals are &eing met$

Participants

The program participants include all !irst and second semester P students" clinical anddidactic instructors" and our Advisory Board Mem&ers$ All !our parttime clinical instructors #eregiven the opportunity to complete the survey$ 1ne instructor completed the survey &ut all !ourprovided detailed narratives in person$ o need !or sampling e-ists &ecause the population o!instructors is small" and the same is true o! students$ Currently" 2 !irst semester and 2 second

semester students are enrolled in the Practical ursing program" and #ith such a small population allsecond semester students #ill &e included in the study" although participation is completely voluntary$

:irst semester students #ere not surveyed due to the !act they have had only one #ee% inclinicals and have not had enough time to &ecome !amiliar #ith the program$ 1! the 2 students as%edto participate in the survey" ; responded$ 3n addition to the instructors and students" all ' AdvisoryBoard Mem&ers present at the March 2'" 2' meeting #ere as%ed to provide input into the processparticipated" ma%ing this a nonrandom" sel!selecting convenience sample$

Procedures

The clinical competencies program #as !ully operational and ran normally #hile the evaluation#as &eing conducted$ Survey 0uestions #ere developed !or each o&,ective and these #ere revie#ed &y

the !ulltime !aculty prior to use$ 1nce the 0uestions #ere !inali+ed surveys #ere created in SurveyMon%ey and made availa&le to sta!! and students !rom March page at the end o! the survey$ Advisory Board mem&ers #ere as%ed !or their input at theAdvisory Board Meeting on March 2'" 2' and their comments #ere recorded !or revie#$

Data Sources

The t#o sources o! data in this evaluation #ere student surveys and clinical instructor surveys$The student and instructor survey 0uestions and ans#ers" along #ith the 0uestions as%ed o! the

advisory &oard mem&ers are included in Appendi- /$ Students and instructors #ere surveyed !romMarch ;" 2' through March 22" 2'$ 3n addition" the ursing Advisory Board mem&ers present atthe March 2'" 2' Advisory Board Meeting #ere as%ed a&out their perceptions o! our students*preparedness &oth at clinicals and as ne# employees$

1nce the surveys #ere closed the data #as compiled and comments e-amined" a ta&le #ascreated to ma%e the results more accessi&le !or all sta%eholders$ Appendi- / lists the 0uestions !romthe student survey and the results" plus the open te-t comments students #rote in a!ter each 0uestion$ 3!the same comment #as made multiple times" one representative comment is provided !ollo#ed &y thenum&er (?) o! times it #as mentioned as a response to that 0uestion$ 3n addition" demographics #erecollected to correlate student ans#ers to age or hours #or%ed per #ee%" !or e-ample$


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Results

This section analy+es the data associated #ith each program o&,ective or 0uestion &eing evaluated$ Theresults indicate that the o&,ectives are &eing met &ut the survey results and the comments indicate thereis room !or improvement$

Clinical Objective 1: Demonstrate critical thining in the use o! the nursing process

Student 0uestions eight and ten as% students a&out the students* perceptions o! their a&ility toapply #hat they have learned in the classroom to their clinical e-periences and #hether they !ind thatthe clinical competencies provide them a #ay to demonstrate their a&ility to critically thin% through thenursing care they provide their patients$ 1ver @' o! the students agree that the clinical competenciesprovide they can apply #hat they have learned and that the clinical competencies help themdemonstrate this a&ility" one student disagreed$ The one !ree te-t response entered stated" =They reallyhelped me apply my critical thin%ing s%ills and recogni+e #hat 3 learned in the clinical setting$>

3nstructor responses to 0uestions to 0uestions @" and 2 indicate that !irst semester studentsare still developing their critical thin%ing s%ills &ut that &y the middle o! the second semester they havemade de!inite improvement in their critical thin%ing s%ills as indicated &y the instructor responses$3nstructors also agree that the clinical competencies mostly or al#ays provide the students a #ay to

demonstrate their critical thin%ing s%ills$ 1ne instructor stated" =By the end o! the clinical rotation it isapparent the students %no# #here to !ind the in!ormation i! they dont %no#$ Especially #ithmedications and the related la&s and ho# it can a!!ect the patient$>

ursing Advisory Board mem&ers are not in a position to spea% to the clinical competenciesspeci!ically" &ut they are a&le to give the P Program an indication o! #hat %ind o! impact the clinicalcompetencies are having once students graduate$ Three ursing Advisory Board mem&ers stated thatthey pre!er to hire MATC P program graduates &ecause" in the #ords o! one mem&er"

our students are ready to hit the !loor #hen #e hire them" and #e hire themover BU year grads #hen possi&le &ecause #hile the BU grads are &oo%smart" your students have actual clinical e-perience and can thin% li%e nurses$

They are not a!raid to ma%e decisions and provide direct patient care$

1ne advisory &oard mem&er approached the Program /irector a!ter the meeting and as%ed tohave more students placed in their clinical site so they #ould &e a&le to evaluate and potentially hiremore MATC graduates$ The results appear to indicate that the clinical competencies are e!!ective inhelping students meet Clinical 1&,ective $

Clinical Objective ": Demonstrate use o! management and leadership principles in the delivery

o! patient care

Student survey results #ere mi-ed !or 0uestions ' and #hich covered prioriti+ation andtime management issues$ This is one area that students generally score lo# on #hen they ta%e their

licensing e-am" the C6EDP" even though these issues are covered at length in multiple classes andthe concepts are #oven throughout the program$ 4hile ' o! the students surveyed !elt thecompetencies did help them learn and demonstrate organi+ation" time management and prioriti+ations%ills" 2' did not$ Clinical instructors indicate that student s%ills improve in these areas !rom !irst tosecond semester" &ut the results are not over#helmingly positive$ The clinical competencies related tothese areas could &e strengthened$

Advisory Board mem&ers also had a lu%e#arm reaction to the students* a&ilities to prioriti+e"manage time and &e organi+ed &ut all agreed that these s%ills ta%e time to learn and that it is not reallyreasona&le to e-pect novice nurses to &e adept at these s%ills #ithout a signi!icant amount o! dailyclinical practice$ Their general consensus #as that the students are a&out #here they are e-pected to &e!or ne#ly graduated" ine-perienced nurses$ There!ore" it appears that Clinical 1&,ective 2 is partially


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met &ut that re#riting the competencies or e-plaining them &etter may help students see the connection&et#een the concepts" the competencies and their clinical e-periences$

Clinical Objective #: Per!orm nursing interventions in a sa!e and e!!ective manner

Student survey 0uestions @ and 5 address student perceptions a&out ho# #ell prepared theythin% they are to #or% as a nurse" and i! they !eel they can per!orm the re0uired s%ills in a sa!e and

e!!ective manner$ 3n other #ords" can students see a direct connection &et#een #hat they are as%ed todo as part o! their clinical education and the ,o& !or #hich they are training9 1nehundred percent o!the students !elt that their clinical e-periences are mostly or al#ays preparing them !or the #or%place"and F o! the students !elt that the competencies provide them a #ay to demonstrate their a&ility toper!orm sa!e and e!!ective nursing care$

The negative comments all seem to stem !rom the students* perceptions that they are not gettingade0uate e-periences in some areas and this perception is causing them some an-iety$ This is acommon issue #ith nursing students and is an e-pected result$ More thorough e-planations a&out #hatcan reasona&ly &e e-pected !rom any clinical e-perience in any setting plus supportive encouragementsurrounding simulation la& use may help ameliorate some o! the an-iety these students e-perience$3nstructors indicated in 0uestions @ and that students are meeting e-pectations regarding physical

assessments" medication administration and sterile techni0ue (all necessary and common s%ills) andthat students are ma%ing progress !rom !irst to second semester$ Advisory Board mem&ers agreed thatMATC P students are sa!e and possess the &asic s%ills they #ould e-pect o! !irst year nurses$ Theyhad no recommendations !or any improvements in this area$

Clinical Objective $: %se therapeutic communication &hile providing nursing care to patients

and their !amilies

Student survey 0uestion as%s a&out therapeutic communication" #hich is an essential s%ill!or anyone #or%ing #ith patients" many o! #hom can &e depressed" !rightened" angry or con!used$Students learn a&out therapeutic communication techni0ues and the importance o! patientcenteredinteractions in the classroom and in the s%ills la&$ The clinical e-perience provides students a #ay to

put #hat they have learned into practice and to try out their &eginning level s%ills #ith the guidanceand support o! their instructors and the nurses #ith #hom they #or%$ Seventythree percent o! thestudents agree that the clinical competencies help them learn ho# to use therapeutic communication#hile 2


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