Transcript Experiences in Competency Development - Dartmouth

Competency for Entry into Practice
Utilizing Human Patient Simulation
Outcomes and Summary
Linda J. Kobokovich, PhD, RN
Director of Nursing Practice &
Administration
Co-Director Nurse Residency Program
Evaluation of Processes
and Outcomes

Quantitative Measures
– Simulated Structured Clinical Scenario
Performance Evaluation (SSCS)
– Self-efficacy for practice - revised
– Level of competence
– Level of confidence
– Readiness for independent practice
– Length of orientation
Evaluation of
Performance - SSCS

Simulated Structured Clinical Scenario
Performance Evaluation (SSCS)
– Attitudes/behaviors
– Technical skills/competency
– Intellectual skills
– Interpersonal skills
NRP: Performance Outcomes

Performance evaluations demonstrate:
– a consistent pattern of increased
proficiency and confidence
– an ability to “think on the fly”
– utilization of resources to problem solve
complex or difficult clinical situations.
Self-Efficacy for Practice


Measured with “Nurse Resident’s
Readiness for Entry-into-Practice
Competence Questionnaire.”
53-item scale – adopted from SelfEfficacy for Professional Nursing
Competencies Instrument (BabenkoMould, Yolando et. al)
Journal of Nursing Education – April
2004, 43 (4), 149-155.
Self-Efficacy for Practice

Components
– Nurse/client relationship (5 items)

“use therapeutic communication techniques”
– Illness/injury prevention (5 items)

“identify actual or potential safety risks to
client”
– Curative/supportive care (43 items)
“collect data from appropriate sources”
 “intervene in a rapidly changing health
situation”

Self-Efficacy for Practice

Alpha = 0.98 (n = 44)
Mean at baseline = 72.75 (SD =
10.95)
Mean at midpoint = 77.21 (SD = 9.90)
Mean at final = 86.44 (SD = 9.10)

Paired t-test (b-f) = -8.444, Sig. <.001



Self-Efficacy for Practice:
Discussion
Most significant changes in scores occur in
items related to
 the use of technology in providing nursing
interventions,
 synthesizing clinical data, and
 making clinical decisions in rapidly changing
health situations.
 physiological integrity (MI, respiratory distress),
Self-Efficacy for Practice:
Conclusion
The revised self-efficacy tool
demonstrates promise in measuring
competency and readiness for entry
into practice.
 The curative/supportive care
component appears to be the most
sensitive.

Level of Confidence,
Competence, and Readiness
for Practice: “Global”


Each presented as a 10 mm visual analog scale.
At first week and last week, nurse residents rate
their level of confidence, competence, and
readiness for practice:
– “Rate your level of CONFIDENCE to independently
provide nursing care to patients with symptoms of the
disease processes or clinical situations you studied
this week.”
– “Rate your level of CONFIDENCE to independently
provide nursing care on your unit.”
– “Rate your level of READINESS to independently
provide nursing care on your unit.”
Level of Confidence,
Competence, and Readiness
for Practice: “Global”




Mean at Baseline
Confidence = 3.20
(SD = 2.24)
Competence = 3.75
(SD = 1.90)
Readiness = 3.55
(SD = 2.17)




Mean at Final
Confidence = 7.43
(SD = 1.44)
Competence = 7.29
(SD = 1.37)
Readiness = 7.54 (SD
= 1.46)
Level of Confidence,
Competence, and Readiness
for Practice: “Global”
Paired t-test
t
df
Sig. (2 tailed)
1 – Global
Confidence
-10.36
37
<.001
2 – Global
Competence
-10.29
37
<.001
3 – Global
Readiness
-9.69
37
<.001
Global Scores at baseline, midpoint,
and final for 3 groups
baseline global conf
12
idence
10
8
baseline global comp
etence
12
4
baseline global read
32
23
39
6
iness
14
final global confide
4
nce
16
2
final global compete
nce
8
0
final global readine
ss
-2
N =
11 11 11
8
Feb
8
8
7
7
7
7
7
April
GROUP
7
26 26 26 23 23 23
July
Level of Confidence,
Competence, and Readiness
for Practice: “Weekly”


Each presented as a 10 mm visual analog scale.
Weekly, nurse residents rate their level of
confidence, competence, and readiness for
practice:
– “Rate your level of CONFIDENCE to independently
provide nursing care to patients with symptoms of the
disease processes or clinical situations you studied
this week.”
– “Rate your level of CONFIDENCE to independently
provide nursing care on your unit.”
– “Rate your level of READINESS to independently
provide nursing care on your unit.”
Level of Confidence,
Competence, and Readiness
for Practice: “Weekly”
Paired t-test
t
df
Sig. (2 tailed)
1 – Weekly
Confidence
-7.21
24
<.001
2 – Weekly
Competence
-6.33
24
<.001
3 – Weekly
Readiness
-4.69
12
<.001
Weekly Confidence,
Competence and Readiness
Mean Confidence Scores by Week
Mean Competence Scores by Week
Mean Readiness Scores by Week
7
7
7
6
6
6
Mean
8
Mean
8
Mean
8
5
5
5
4
4
4
3
CONF1
CONF3
CONF2
CONF5
CONF4
CONF7
CONF6
3
COMP1
CONF9
CONF8
CONF10
COMP3
COMP2
COMP5
COMP4
COMP7
COMP6
COMP9
COMP8
COMP10
3
READY1
READY3
READY2
READY5
READY4
READY7
READY6
READY9
READY8
READY10
NRP: C/C/R Outcomes

There is consistent improvement in
confidence, competence and readiness
for practice for recent graduate nurses
who participate in the Nursing
Residency Program.
Length of Orientation

Medical/Surgical Track
– Median: 14.74 weeks
– Range: 9.7 – 19.43 (outlier = 24)

Special Care Areas
– Median: 14.68

Critical Care
– Median: 26.47
ICN: 34 (outlier = 18)
PICU: 22
ICU: 22 - 26
NRP: Length of
Orientation Outcomes


Nurse residents complete orientation
in a consistent time frame, based upon
area of practice
Anecdotal decrease in length of
orientation
Evaluation of Process and
Outcomes

Qualitative Measures
– Feedback from clinical/administrative leadership
 Clinical nurse specialist, unit-based educator,
unit leaders, or department directors.
– Feedback from participants
 Evaluation of didactic content
 Evaluation of each laboratory experience for
clinical pertinence.
Feedback from Unit
Leadership

Nurse residents:
– more predictably take full patient
assignment,
– come prepared with skills previously
missing,
– early detection of performance concerns
and can support learning earlier and
more effectively.
Evaluation of Simulated
Experiences

Should SSCS be part of residency program?
Yes – 96.5%

Has the SSCS and related content been
helpful?
Yes – 98.7%

No - 4.4%
No - 1.8%
Has the SSCS helped you develop your
confidence
Yes – 94.7%
No - 6.1%
Evaluation of Simulated
Experiences


96.5% of respondents rated SSCS
session as “very good” or “good.”
78.5% would like additional or more
advanced simulation training.
NRP: Nurse Resident Feedback


“… it helped me to get over my nervous
feelings related to an emergent situation. It
also helped to remind me to check and
double check.”
“Great hands-on learning experience. The
scenarios force you to think through the
situation and make a judgment. This is a
great way to put what we have learned into
practice.”
NRP: Program Outcomes



A structured residency decreases orientation and
increases clinical productivity.
Preceptors and unit leadership report an
increased readiness for practice and a more
consistent process for the acquisition of skills
Residents report the importance of utilizing
resources and can effectively identify and access
appropriate resources.
NRP: Program Outcomes
- HPS


Human Patient Simulation helps supports
realistic assessment of clinical confidence
and competence and readiness for practice
in a specific clinical setting.
Human Patient Simulation provides
opportunities to assess not only
performance and competence, but more
importantly attitudes and behavior.
Concerns about Recent
Graduates






Lack of experience in medication
administration (IVs, IV push
medications)
Calculations of any type
Medical versus surgical asepsis
Assisting with procedures
Managing emergencies
Readiness to learn more