Portfolios: Implications for perioperative education, evaluation & competency Assessment

Michelle M. Byrne RN, PhD, CNORKathryn Schroeter RN, PhD, CNOR

CCI Research Committee:Michelle Byrne, RN, PhD, CNOR - Chair

Kathryn Schroeter, RN, PhD, CNOR – CCI Board Liaison

Teresa Delarose, RN, MN, EdD, CNOR

Cecil A. King, RN, MS, CNOR, APN

Jane Leske, RN, PhD, APRN-BC

Nancymarie Philips, RN, MSEd, CNOR

Kathryn G. Sapnas, RN, PhD, CNOR, CCRN

• What do you think of when you think of a portfolio?

Portfolio - formal definition

Mechanism for evaluation of competencies that may otherwise be difficult to assess, such as practice-based improvements, use of scientific evidence in practice, professional behavior and creative endeavors.

Artist Portfolio Contents

Artistic products demonstrating a variety of media, foci, and technique.

External review by peer or faculty

Teacher Portfolio Contents

Academic credentials Faculty and peer evaluations Research and publications Service to institution or

community Student evaluations Course materials-syllabi &

assignments.

Student Portfolio Contents

Progressive learning. Skill checklist Best exemplars of work. Development of self

assessment skills. Reflective learning. Faculty evaluations.

Physician Portfolio Contents

Course completion or contact hours Certificate requirements Licensing requirements Residency/fellowship applications Peer evaluation Publications and research

Portfolios

Dynamic and offer a fuller and richer image of the individual than paper and pencil evaluation tools.

Informal definition: A Portfolio is a Scrapbook of your career

•Photos

•Work products

•Educational offerings or attendance

•Annual evaluations

•Letters from employers or patients

Your Portfolio!

Perioperative Care Plan

Mentoring / Precepting

Standards & Recommended Practices CQI

Continuing Education

Clinical Pathway

Domains of Perioperative Nursing

Based on Perioperative Job Analysis

Perioperative Nurse Competency Continuum Study

Involvement of Task Force CNOR’s

Thomson Prometric staff

Domains of Perioperative Nursing

Patient assessment & Dx Identify expected outcomes

& develop plan of care Intraoperative activities Communication Discharge planning

Domains of Perioperative Nursing

Cleaning, disinfecting, packaging & sterilizing

Emergency situations Management of personnel,

services, & materials Professional activities

Types of Professional Activities

Nursing care planning Clinical pathway

development/utilization Development of educational resources Personal continuing education Application project re: AORN

standards or PNDS Continuous quality improvement

project Evidence-based practice initiative

Types of Professional Activities

Risk management activities Mentoring / Precepting roles Leadership role Educational presentations Professional writing Academic course completion

Reflective Learning

Reflection is the process of learning from experience.

Reflection allows you to use your experience to determine what you may do differently as a result of the learning.

Reflection aids ongoing self-assessment & ensures your learning is current and relevant to your practice.

Reflection Narratives

Thoroughly describe the activity/ project/ event.

What happened or occurred?

Clearly describe your role.

What do you know now that you did not know before?

Reflection Narratives

What have you learned? What would you do

differently? How will you build on this

experience? What are the

implications for perioperative nursing practice?

What’s in your portfolio?

Contributions to professional organizations

Local chapter AORN State Nursing Association Sigma Theta Tau

Educational Presentation

Staff workshop AORN chapter continuing

education Staff orientation (At least three 1 hour

presentations are required) Include time/date of presentation,

objectives, outcomes, topic outline or handouts, learner evaluations.

Evidence Based Practice

Provide examples of how research findings were used to validate or change your practice.

Risk management Research utilization Research participation Policy/Procedure involvement PNDS

Professional Writing

AORN Journal article Specialty assembly

newsletter article Employer

publication Chapter newsletter Letter to the editor

Educational resources

Patient education guide Employee guide Perioperative inservice Instructional forms

Continuing Education

Narrative of HOW continuing education changed your practice.

“After attending this conference, I have an increased awareness of fuel sources and how flammable prep agents are. I am much more verbal in communicating with other team members about the importance of letting prep solutions dry before giving the cautery to the surgeons.”

Application of Recommended Practices or PNDS

How was this used in your professional practice?

Policy/procedure creation or revision

Medical legal cases

Academic Courses

Related to perioperative nursing

Either taught or taken—provide syllabus / grade

Examples: Specific or general

Precepting / Mentoring

Provide a narrative including name(s) / credentials of those whom you precepted or mentored along with contact information for a registered nurse colleague who can verify that the information is true and correct.

Students, new staff, faculty, etc.

Nursing Care Plan

Provide a nursing care plan that you have developed or modified that illustrates how you were able to individualize a plan of care based on assessment data.

Safety protocols, reporting, communication, environmental control, documentation, etc.

Clinical Pathway

Provide a copy of a clinical pathway for which you have participated in the development, revision or utilization for a specific patient population.

Continuous quality initiative

Provide an example of a continuous quality improvement plan that you developed or participated in that improved perioperative patient care & outcomes.

Survey data utilization Provision of technical

assistance on a surgical product or new technology

Certification is linked to continued competency.

Continued Competency

Defined as the application of knowledge and the interpersonal, decision-making, and psychomotor skills expected for the nurse’s practice role, within the context of public health and safety.

(NCSBN 1996, 1998)

Why continued competency?

Institute of Medicine (IOM): Mandate to reduce patient errors. Rate of change and information

explosion demands ongoing learning from professionals.

The Current Common Competency requirements for nursing licensing boards is continuing education.

Do you believe that CE guarantees competency?

How does one demonstrate learning?

It’s more than just sitting at an educational session at a conference…

“You don’t know what you don’t know”

“Remember what it was like to not know what you now know”

“It was good enough when I graduated…”

ANA Code of Ethics(Provision 5) The nurse owes the same duties

to self as to others, including the responsibility to preserve integrity & safety, to maintain competence, & to continue personal and professional growth.

PEW Task Force on Health Care Workforce Regulation

Performance monitoring Proctoring Simulation Continuous clinical

practice evaluation

Monitoring may include:

Chart review Evaluation of clinical

practice patterns Simulation Proctoring External Peer Review

Portfolio Evaluation/rating process

Credibility Dependability Confirmability Adequacy and

appropriateness of data Multiple raters

Portfolio Review

Evidence will be reviewed and judged as meeting or not meeting criteria.

Two raters-third if disagreement.

Reviewers-CNORs

Assessment or Evaluation

Formative (professional growth and development)

Vs

Summative (final evaluation of criteria met/unmet)

Portfolios-Developing a process for CNOR recertification/reactivation

Personal accomplishment

Accountability Personal

satisfaction Professional

credibility

Consumer confidence

Recognition from others

Marketability

CCI Initiatives

Publish information on portfolio utilization in competency assessment

Pilot the portfolio project in 2007

Plan to implement the portfolio for recertification and reactivation of CNOR credential in 2008.

Portfolios: Tips

Time consuming —

For creator and evaluator!

But it doesn’t have to be!