competency based distance nursing education: clinical testing vs. clinical teaching mary lee...
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Competency Based Distance Competency Based Distance Nursing Education: Clinical Nursing Education: Clinical Testing vs. Clinical TeachingTesting vs. Clinical Teaching
Mary Lee Pollard, PhD, RN Associate Dean Kim Hedley, MS, RN, CPHQ, Senior Program Director
Excelsior College School of Nursing
History of Excelsior History of Excelsior CollegeCollege
Founded in 1971 by New York State Board of Regents
Chartered by the Regents as an independent institution in 1998
Formerly Regents College Changed name in 2001 to
Excelsior College
History of the AD Nursing History of the AD Nursing ProgramProgram First faculty came together in 1970 Purpose was to block this
innovative model Once convinced of worthiness of
the model, faculty “made sure it was done right”
Faculty represented nationally known nurse leaders
40 year history of success Graduates exceeding 33,000
Excelsior College Excelsior College PhilosophyPhilosophy
What you know is more important than where or how you learned
it.®
Excelsior College MissionExcelsior College Mission
Expand educational opportunity with a particular concern for those historically underrepresented in higher education by focusing on the needs of the individual student and offering flexible, self-paced academic options.
Competency Based Competency Based EducationEducation
Learner focused rather than teacher focused
Documentation rather than assumption
Outcome focused rather than process focused
Competence rather than completion
Competency Based Competency Based Education is Based on Education is Based on
Principles of Adult LearningPrinciples of Adult Learning
Treat the learner as an adult Learners have individual learning
needs Learners are self-directed and
motivated Learners are responsible for their
own learning
Competence and Competence and CompetencyCompetency
Competence is defined as having the knowledge, skills and abilities required to perform the job.
Competency is defined as the ability to perform required skills in accordance with established standards.
Clinical Education ModelsClinical Education Models
Traditional- apprenticeship; focus on process of instruction and repetition, faculty drive the teaching and evaluation
Non-traditional- assessment, competency-based; focus on outcomes of learning
Traditional Clinical Evaluation Traditional Clinical Evaluation MethodMethod
Clinical grade equated with observed clinical competency
Use formative evaluations to make judgments about practice ability
Doesn’t address the demand for accountability in higher education- measurable outcomes
Competency Based Distance Competency Based Distance Nursing EducationNursing Education
Challenges: Changes way of thinking Need clear and specific language
related to evaluation criteria Pilot testing and working out the
“glitches” essential
Competency Based Distance Competency Based Distance Nursing EducationNursing Education
Opportunities:
Increase student and faculty satisfaction
Increase objectivity and minimize bias Responsive to demands for more
accountability
Criticisms of Competency Criticisms of Competency Based EducationBased Education
Grounded in behaviorist pedagogy (content driven curriculum with specific outcomes and objectives)
Focus on work related knowledge and skills at the expense of broader analytical skills
Difficult to justify liberal education in competency based model
How Excelsior College How Excelsior College Assesses Learning and Assesses Learning and
CompetenciesCompetencies Criterion referenced
-theory examinations that measure nursing knowledge
-performance examination that includes the use of simulations and real-time performance appraisal
Concepts and Concepts and PerspectivesPerspectives
Teaching versus Learning
Theory versus Performance
Evaluation versus Examination
Assumption versus Documentation
Completion versus Competence
Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical
EvaluationEvaluation
Examination versus Instruction
Areas of Care versus Specific
Tasks
Critical Elements versus Steps in
Procedure
Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical
EvaluationEvaluation
Objectivity versus Subjectivity
Sampling versus Total Content
Acceptability versus Ideal
Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical
EvaluationEvaluation
Consistency versus Variability
Flexibility versus Rigidity Systematized Conditions versus
Spontaneous Arrangements
Clinical Performance in Clinical Performance in Nursing Examination Nursing Examination
(CPNE(CPNE®)®)
The capstone of Excelsior College’s external associate degree in nursing program.
Given over 2 ½ days in one of 21 testing sites throughout the country.
Students must successfully pass:– 4 Nursing Simulation Laboratories– 2 Adult Patient Care Situations (PCS)– 1 Pediatric Patient Care Situation (PCS)
Nursing Process/Critical Nursing Process/Critical ThinkingThinking
A problem solving that involves: Assessment Analysis Planning Implementation Evaluation
Areas of CareAreas of Care
Clusters of nursing activities that incorporate similar
principles or competencies.
Areas of Care (cont)Areas of Care (cont)
Overriding Areas of Care: Tested during the Patient Care Situations (PCS) and the Nursing Simulation Laboratory
Required Areas of Care: Tested in every PCS
Selected Areas of Care: Sampled throughout the PCSs. Medication administration must be tested at least once during the PCSs
Each Area of Care is comprised of critical elements
Critical ElementsCritical Elements
Single, discrete, observable behaviors used in measuring the student’s performance
Minimum requirements for beginning RN practice
CPNECPNE®® Roles – Clinical Roles – Clinical Associate (CA)Associate (CA)
Coordinates and supervises the administration of the CPNE
Ensures the CPNE is conducted in a manner consistent with the information published in the CPNE Study Guide
Reviews and verifies failures
CPNECPNE®® Roles – Student Roles – Student
Performs in a manner consistent with expected standards for ethical and professional practice.
Complies with the Academic Honesty Policy
Perform all aspects of the simulations and nursing care under the direct observation of the Clinical Examiner
CPNECPNE®® Roles – Clinical Roles – Clinical Examiner (CE)Examiner (CE)
Promotes a collaborative relationship with nursing staff
Orients the student to the nursing unit and equipment necessary to complete the PCS
Selects patients according to established guidelines
Acts as a silent observer. Observes student’s performance at all
times. Promotes positive neutrality Acts as a Patient Advocate
Clinical Examiner (CE) Clinical Examiner (CE) Training Training
Clinical Examiners undergo the same rigorous training, retraining and evaluation geared towards controlling bias and maximizing equitable treatment of the candidates.
Master’s prepared nurse educators, experienced in performance assessment and the administration of the CPNE, conduct the training..
Clinical Examiner Training Clinical Examiner Training (cont)(cont)
Training in offered in 3 phases and the CEs:– Are grounded in the principles of
performance assessment.– Learn the administration protocols for
the NSL stations and PCS.– Learn to differentiate between clinical
evaluation (focus on learning) and clinical performance assessment (systematic data collection via testing)
Clinical Examiner Training Clinical Examiner Training (cont)(cont)
– Learn the function and accurate use of the scoring tools.
– Learn to provide neutral and consistent communication
– Learn the expectations for dealing with both pass and fail circumstances.
CEs and CAs participate in the Annual Update during which changes in examination structure or process are reviewed and issues or concerns from test sites are discussed.
Excelsior College OutcomesExcelsior College Outcomes
Higher than average NCLEX first time pass ratefor 2004-2008
National average 86.34%Excelsior College 87.85%
Students perceive the program as rigorous yet very workable; it fits their lifestyle and they develop a strong sense of self-confidence as a result of their efforts
Costs/Benefits to a Costs/Benefits to a Competency Based Model of Competency Based Model of
EvaluationEvaluation Costs
-training of faculty examiners-quality assurance measures-ongoing research-letting go of what is familiar
and comfortable and doing things differently
Costs/Benefits to a Costs/Benefits to a Competency Based Model of Competency Based Model of
EvaluationEvaluation Benefits
-addresses issues of limited clinical placements
-addresses issues of faculty shortage-valid and reliable; minimizes opportunity for bias-student satisfaction
Summary- Competency Summary- Competency Based Distance Nursing Based Distance Nursing Education:Education:
Competency based curriculum Derived using expert educators
and practitioners
Focus on outcomes
Clearly articulated competencies
Summary- Competency Summary- Competency Based Distance Nursing Based Distance Nursing Education:Education:
Publicized expectations of learners Criterion referenced evaluation
methods
Remediation cycle
Learner centered
What Does the Research What Does the Research Say?Say?
The large majority of nurse supervisors surveyed rated the overall clinical competence of Excelsior College AD nursing graduates as the same or higher than other associate degree nurses (Gwatkin, Hancock, & Javitz, 2009).
What Does the Research What Does the Research Say?Say?
Mentor/preceptors rated the overall clinical competence of Excelsior College AD nursing graduates as slightly higher compared to other associate degree graduates (Darrah, & Humbert, 2009).
Darrah, M., Humbert, R. (2009). Excelsior College final evaluation report. ProEvaluators.
Gwatkin, L., Hancock, M., & Javitz, H. (2009). As well prepared, and often better: Surveying the work performance of Excelsior College associate degree in nursing graduates. SRI International.
both studies available via :www.excelsior.edu/excelsior_college/publications