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
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
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
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Knowledge
Comprehension
Application
Analyze
Synthesize
Evaluate
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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.
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© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. [email protected]
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. [email protected]
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
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© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. [email protected]
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
HOW?
What does competence look like?
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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.
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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)
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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
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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”
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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?
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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
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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]
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.
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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
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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
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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
Preceptor development and support
Clinical Coaching Plan - Development of Critical Thinking
Preceptors
Interns
Clearly defined expectations Standardized performance outcomes (COPA)
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.
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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
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OrientationCompetency assessmentPreceptor program
Establish the timeframe Identify resources Time to teach
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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
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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
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