At the COPA…At the COPA…Looking at QSEN and Competency Outcomes Looking at QSEN and Competency Outcomes

Performance Assessment ModelsPerformance Assessment Models

University of Colorado Denver College of NursingUniversity of Colorado Denver College of Nursing

Amy Barton, RN, PhDAmy Barton, RN, PhDGail Armstrong, RN, NDGail Armstrong, RN, ND

Gayle Preheim, RN, EdD, CNAA BC, CNEGayle Preheim, RN, EdD, CNAA BC, CNE

New Academic Year, New Campus, New New Academic Year, New Campus, New School Name, New Curricular ParadigmSchool Name, New Curricular Paradigm

Where do we want to go, and what have we Where do we want to go, and what have we learned from our experience?learned from our experience?

Progress, far from consisting in Progress, far from consisting in change, depends on retentiveness. change, depends on retentiveness. When experience is not retained…When experience is not retained…infancy is perpetual. Those who infancy is perpetual. Those who cannot remember the past are cannot remember the past are condemned to repeat it. This is the condemned to repeat it. This is the condition of children and barbarians in condition of children and barbarians in whom instinct has learned nothing whom instinct has learned nothing from experience.from experience.

George Santayana (1905)George Santayana (1905)

Colorado’s QSEN team’s Colorado’s QSEN team’s approachapproach

Several collaborative Several collaborative workshops were held workshops were held for CON faculty and for CON faculty and our clinical partnersour clinical partners What is QSENWhat is QSEN How does QSEN How does QSEN

interface with COPA?interface with COPA? What safety and quality What safety and quality

initiatives are occurring initiatives are occurring in the clinical agencies?in the clinical agencies?

Integration of QSEN with Integration of QSEN with COPACOPA

A framework and process developed A framework and process developed by Carrie Lengerg to promote intial by Carrie Lengerg to promote intial and continuing competence by and continuing competence by integrating:integrating:

CCompetence for contemporary practiceOutcomes to be achieved for practicePerformance of essential competenciesAssessment structured for competence

The COPA ModelThe COPA Model

Creates “end-result” Creates “end-result” competence outcomescompetence outcomes focusing on eight focusing on eight practice based core practice based core competencies based competencies based on today’s nursing on today’s nursing needsneeds

Focuses on Focuses on learner learner competencecompetence and and continued continued developmentdevelopment

Summary of COPA ProcessSummary of COPA Process

Create outcome statements that are:Create outcome statements that are:

Clear, precise, realistic, practice based, Clear, precise, realistic, practice based, measurablemeasurable

↓↓Use interactive learning strategies that are most Use interactive learning strategies that are most

effective in achieving competenceeffective in achieving competence↓↓

Evaluate the student through Competency Evaluate the student through Competency Performance Evaluations (CPEs)Performance Evaluations (CPEs)

Lots of overlap between COPA Lots of overlap between COPA and QSENand QSEN

Both models:Both models: Based in a value model Based in a value model

that emphasizes that emphasizes competence to protect competence to protect patient safetypatient safety

Rely on collaborative Rely on collaborative work with clinical work with clinical agencies to define the agencies to define the most current trends in most current trends in nursing practicenursing practice

Employ an integrative Employ an integrative paradigm in defining paradigm in defining what is “nursing practice”what is “nursing practice”

Eight Core COPA practice Eight Core COPA practice competencies and QSEN KSAscompetencies and QSEN KSAs

COPA CompetencyCOPA Competency QSEN KSAQSEN KSA1) Assessment and Intervention skills1) Assessment and Intervention skills Patient SafetyPatient Safety2) Communication Skills2) Communication Skills Teamwork/CollabTeamwork/Collab

InformaticsInformatics3) Critical Thinking Skills3) Critical Thinking Skills EBPEBP4) Human Caring/Relationship skills4) Human Caring/Relationship skills Patient Cent. CarePatient Cent. Care5) Teaching Skills5) Teaching Skills Patient Cent. CarePatient Cent. Care6) Management Skills6) Management Skills Quality Improv.Quality Improv.7) Leadership Skills7) Leadership Skills Teamwork/Collab.Teamwork/Collab.8) Knowledge Integration Skills8) Knowledge Integration Skills EBPEBP

Dr. Christine Tanner’s Integrative Model of Clinical Dr. Christine Tanner’s Integrative Model of Clinical JudgmentJudgment

Tanner, C.A. (2007) Thinking Like a Nurse: a research based model of clinical judgment. Tanner, C.A. (2007) Thinking Like a Nurse: a research based model of clinical judgment. Journal of Nursing EducationJournal of Nursing Education, 45(6), 204-211., 45(6), 204-211.

Importance of a Importance of a Developmental Approach to Developmental Approach to

KSAsKSAs ““The biggest difference between a The biggest difference between a

novice and an expert is a sense of novice and an expert is a sense of salience.” salience.” Patricia BennerPatricia Benner

BeginningBeginning IntermediateIntermediate AdvancedAdvancedHealth AssessmentHealth Assessment OBOB Med/Surg IIMed/Surg II

FundamentalsFundamentals PedsPeds Public HealthPublic Health

Med/Surg IMed/Surg I Mental HealthMental Health Senior Integ.Senior Integ.

PracticumPracticum

Specific Examples of CON’s Specific Examples of CON’s curricular updatescurricular updates

Health AssessmentHealth Assessment Substantive introduction to EBPSubstantive introduction to EBP

Fundamentals of NursingFundamentals of Nursing Safety: National Patient Safety Goals, 5 Million Lives Campaign, IOM Safety: National Patient Safety Goals, 5 Million Lives Campaign, IOM To To

Err Is HumanErr Is Human, Fall Program in VA hospitals from DOD, CHA Armband , Fall Program in VA hospitals from DOD, CHA Armband InitiativeInitiative

EBP: IOM’s EBP: IOM’s Quality ChasmQuality Chasm Patient Centered Care: Picker Institute Report, Patient Centered Care: Picker Institute Report, Patient Centered Care: Patient Centered Care:

What does it take? ,What does it take? ,Harvard Hospitals’ Collaborative: Harvard Hospitals’ Collaborative: When Things Go When Things Go Wrong: Responding to Adverse EventsWrong: Responding to Adverse Events, Transcultural Nursing Care, Transcultural Nursing Care

Quality Improvement: IOM’s Quality Improvement: IOM’s Crossing the Quality ChasmCrossing the Quality Chasm and and More on More on QualityQuality; articles on 10/08 Medicare’s policy to withhold payment for ; articles on 10/08 Medicare’s policy to withhold payment for hospital errors; Atul Gawande’s article on Dr. Pronovost’s work on QI in hospital errors; Atul Gawande’s article on Dr. Pronovost’s work on QI in the ICU environmentthe ICU environment

Teamwork & Collaboration: SBAR, TeamSTEPPS, IHI’s work on Rapid Teamwork & Collaboration: SBAR, TeamSTEPPS, IHI’s work on Rapid Response TeamsResponse Teams

Informatics: Graves and Corcoran, “The Study of Nursing InformaticsInformatics: Graves and Corcoran, “The Study of Nursing Informatics””

What have we learned?What have we learned?

Our faculty suffer Our faculty suffer from the silo from the silo phenomenon; they phenomenon; they are most are most comfortable being comfortable being autonomous and autonomous and independent of independent of other other courses/facultycourses/faculty

What else have we learned?What else have we learned?

Our faculty have not Our faculty have not historically thought historically thought much about the much about the education-service education-service chasm. QSEN chasm. QSEN facilitates a much facilitates a much more smooth more smooth transition from transition from school into practice school into practice for our new for our new graduates.graduates.

And what else have we And what else have we learned?learned?

In our BS curriculum In our BS curriculum there are developmental there are developmental gaps that do not support gaps that do not support students as they students as they transition from our transition from our beginning level classes beginning level classes to our intermediate level to our intermediate level classes and then into our classes and then into our advanced level classes. advanced level classes. We need to purposefully We need to purposefully bridge these transitions bridge these transitions for our students.for our students.

How are we responding to How are we responding to these lessons?these lessons?

QSEN Implementation Team (5 members)QSEN Implementation Team (5 members) Two members of the QSEN grant team, the Director of the Two members of the QSEN grant team, the Director of the

Learning Laboratory, the Director of the Simulation Learning Laboratory, the Director of the Simulation Laboratory, and a clinical liaison employed by the CON Laboratory, and a clinical liaison employed by the CON and our largest clinical partner (UCH)and our largest clinical partner (UCH)

Explicit facilitation of the threading of the QSEN KSAs Explicit facilitation of the threading of the QSEN KSAs throughout our BS Program:throughout our BS Program:

Here is what the classes before and after yours are Here is what the classes before and after yours are covering in QSEN – how will you build upon these KSAs covering in QSEN – how will you build upon these KSAs and prepare students for the next developmental and prepare students for the next developmental stage?stage?

How are the QSEN KSAs present in your Learning How are the QSEN KSAs present in your Learning Laboratory activities? In your simulation activities? In Laboratory activities? In your simulation activities? In your clinical roation activities?your clinical roation activities?

What competence outcomes for your class overlap What competence outcomes for your class overlap with the QSEN KSAs?with the QSEN KSAs?

Development of common Development of common faculty/clinical partner QSEN faculty/clinical partner QSEN

resourcesresources Development of Development of

QSEN modules on QSEN modules on HealthStream for HealthStream for fculty and clinical fculty and clinical partnerspartners

EBP and Evidence Based Educational EBP and Evidence Based Educational modelsmodels

We know that evaluation and We know that evaluation and collection of the right data are collection of the right data are important:important:

Participation in QSEN survey Participation in QSEN survey to our May ’08 graduating to our May ’08 graduating seniorsseniors

After our “intervention group” After our “intervention group” graduates, we will survey graduates, we will survey them about their percpetion them about their percpetion of the impact of QSEN content of the impact of QSEN content on their practiceon their practice

We will also survey our We will also survey our clinical partners about any clinical partners about any differences they see in our differences they see in our new grads whose curriculum new grads whose curriculum had a strong QSEN foundationhad a strong QSEN foundation

Ongoing reflections…Ongoing reflections…

The Chinese symbol for The Chinese symbol for crisis is the symbol of crisis is the symbol of danger over the symbol danger over the symbol for opportunityfor opportunity Danger: How do we Danger: How do we

broaden our BS faculty’s broaden our BS faculty’s perspective enough so that perspective enough so that QSEN is not “another thing QSEN is not “another thing to add to my course?”to add to my course?”

Opportunity: Our first Opportunity: Our first group of students are truly group of students are truly asking new questionsasking new questions

Strategic planning Strategic planning for the future is the for the future is the most hopeful most hopeful indication of our indication of our increasing social increasing social intelligence.intelligence.

William HastieWilliam Hastie

One last thought….One last thought….

It’s not because It’s not because things are difficult things are difficult that we dare not that we dare not venture. It is venture. It is because we dare because we dare not venture that not venture that they are difficult.they are difficult.

Seneca (mid 1st century Roman

philosopher)

Many thanks…Many thanks…

Any questions?Any questions?