DNP Toolkit Process and Approach to DNP Competency Based Evaluation 2011 A Product of the NONPF Curricular Leadership Committee Co‐Editors Carla Dieter, EdD, FNP‐BC, University of South Dakota, Sioux Falls,SD (formerly with South Dakota State University, Brookings, SD) Thomasine Guberski PhD,CRNP, University of Maryland, Baltimore, MD National Organization of Nurse Practitioner Faculties 900 19th Street, NW, Ste. 200B, Washington, DC 20006 http://www.nonpf.org 1 Contributors Competency‐Based Education Melinda Swenson, PhD, FNP, Indiana University School of Nursing, mswenson@iupui.edu Michaelene P. Jansen PhD, RN,C, GNP‐BC, NP‐C, FAANP, University of Wisconsin ‐ Eau Claire, mirrmp@uwec,edu Sharon Sims, RN, PhD, FAANP, ANEF, Indiana University School of Nursing, ssims@iupui.edu Kathleen Reeve, University of Texas Health Science Center, kathleen.reeve@uth.tmc.edu, reevek@uhv.edu Shirlee Drayton‐Brooks, PhD, CRNP, FNP‐BC, FAANP, Widener University, smdrayton‐brooks@widener.edu Competency Area: Independent Practice Carla Dieter, EdD, FNP‐BC, University of South Dakota (formerly with South Dakota State University), Carla.dieter@usd.edu Judith McDevitt PhD, FNP‐BC, University of Illinois, Chicago, jmcdev1@uic.edu Veronica Wilbur PhD FNP‐BC, CNE, Wilmington University, veronica.f.wilbur@wilmu.edu Andrea Wolf, DNP, CRNP, York College of Pennsylvania, awolf3@ycp.edu Competency Area: Scientific Foundation Thomasine Guberski, PhD, CRNP, University of Maryland, Guberski@son.umaryland.edu Zena Hyman DNS, CNE, ANP‐BC, Daemon College, zhyman@daemen.edu Donna Behler McArthur, PhD, FNP‐BC, FAAN, Vanderbilt University School of Nursing, donna.mcarthur@vanderbilt.edu Patricia Shaver PhD, ANP, GNP, Rapid City, SD Patricia.Shaver@sdstate.edu Competency Area: Leadership Thomasine Guberski, PhD, CRNP, University of Maryland, Guberski@son.umaryland.edu Shirley Dinkel, PhD, ARNP, Associate Professor, Washburn University, Topeka, KS shirley.dinkel@washburn.edu Competency Area: Quality Carla Dieter, EdD, FNP‐BC, University of South Dakota (formerly with South Dakota State University), Carla.dieter@usd.edu Thomasine Guberski, PhD, CRNP, University of Maryland, Guberski@son.umaryland.edu Competency Area: Practice Inquiry Thomasine Guberski, PhD, CRNP, University of Maryland, Guberski@son.umaryland.edu Katherine Crabtree, DNSc., APRN, BC, FAAN, University of Portland, crabtrek@up.edu 2 Competency Area: Technology & Information Literacy Carla Dieter, EdD, FNP‐BC, University of South Dakota (formerly with South Dakota State University), Carla.dieter@usd.edu Leigh Ann McInnis, PhD, FNP‐BC, Middle Tennessee State University, lmcinnis@mtsu.edu Joyce M. Knestrick, PhD, CRNP, FAANP , Frontier School of Midwifery and Family Nursing, joyce.knestrick@frontierschool.edu Brigid Warren, RN MSN CS, Michigan State University, brigid.warren@hc.msu.edu Competency Area: Policy Carla Dieter, EdD, FNP‐BC, University of South Dakota (formerly with South Dakota State University), Carla.dieter@usd.edu Carol Savrin RN, DNP, CPNP, FNP,BC, FAANP,Case Western Reserve University, cls18@case.edu Karen Greco, PhD, RN, ANP‐BC, Genetics Branch, Center for Cancer Research; University of Arizona, kgreco@nursing.arizona.edu Ann O’Sullivan, PhD, FAAN, CRNP, University of Pennsylvania, osull@nursing.upenn,edu Competency Area: Health Delivery System Thomasine Guberski, PhD, CRNP, University of Maryland, Guberski@son.umaryland.edu Vaunette Fay, PhD, RN, FNP‐BC, GNP‐BC,University of Texas Health Science Center at Houston,Vaunette.P.Fay@uth.tmc.edu Marie Napolitano, RN, PhD, FNP, University of Portland, napolita@up.edu Lorraine Reiser, PhD, CRNP, Clarion University of Pennsylvania, lreiser@clarion.edu Competency Area: Ethics Carla Dieter, EdD, FNP‐BC, University of South Dakota (formerly with South Dakota State University), Carla.dieter@usd.edu Carol A. Smith DSN, CRNP, The Pennsylvania State University, CAS35@psu.edu Sheila Melander, DSN, ACNP‐BC, FAANP, FCCM, University Tennessee Health Science Center, Memphis, TN smelande@uthsc.edu Nancy Rogers, PhD, RN, CNS, FNP‐BC, Texas A & M University‐Corpus Christi Review & Editorial Contributions Mary Burman,PhD, RN, FNP‐BC, University of Wyoming, mburman@uwyo.edu Geraldene Budd, PhD, RN, FNP‐BC, CRNP, FAANP, Widener University, gmbudd@widener.edu Shirlee Drayton‐Brooks, PhD, CRNP, FNP‐BC, FAANP, Widener University, smdrayton‐brooks@widener.edu Marva Price, DrPH, RN, FAANP, FAAN, Duke University, Marva.price@duke.edu 3 DNP Toolkit Process and Approach to DNP Competency Based Evaluation Updated 2011 The National Organization of Nurse Practitioner Faculties (NONPF) is committed to the ongoing refinement of competency‐based education for nurse practitioners (NPs). Faculty must be engaged in the scholarship of teaching, have an in depth understanding of practice realities, and the tools to support the teaching and learning process. Thus, this toolkit is designed to assist faculty in competency‐based evaluation of the DNP student. The sample Faculty/Program Resources section contains article citations, exemplar course materials, and other tools to assist faculty in development of competency‐based education and evaluation. Competency‐Based Education and Evaluation in the Doctor of Nursing Practice Degree Competency‐based education (CBE) emerged in the United States in the 1970s and refers to an educational movement that advocates defining educational goals in terms of precise measurable descriptions of knowledge, skills, and attitudes that students should possess at the end of an educational program (Savage, 1970). There are varying definitions of competencies. NONPF subscribes to definitions that view competencies as knowledge, skills and abilities that are necessary to care for the public’s well being in varying states of health. For example, a competency is a skill performed to a specific level of competency or proficiency under specific conditions. The US Department of Education (2002) defined competence as a combination of skills, ability and knowledge needed to perform a specific task. Finally, competencies are defined as consisting of a description of the essential skills, knowledge, attitudes, and behaviors required for effective performance (Mrowicki, 1986). Competency based education focuses on outcomes of learning The emphasis in education must be focused on the learner, the learning outcomes, and the practice environment (U.S. Department of Education, National Center for Education Statistics, 2002). The emphasis must be on what NPs need to know and be able to do in varying and complex situations. The learning outcomes and competencies must be linked to the environmental context, professional and public expectations, and must be relevant to chaotic and changing health care system. Different settings, different roles and varying population combination require new competencies, thus the necessary proliferation of competency statements to inform curricula. Competencies reinforce one another in the learning process, and new requisites emerge as a result of increasing complexity. 4 Competencies (Behaviors & Measures) Learner Learning Outcomes (Essential achievement & Characteristics of learners) Environmental context Professional & Public expectations Dynamic, chaotic, changing healthcare Changing Knowledge, Skills. & Attitude (KSA) Requisite in response to complexity Illustration: Drayton‐Brooks (2011). Informed by U.S. Department of Education, National Center for Education Statistics. Defining and Assessing Learning:Exploring Competency‐Based Initiatives, NCES 2002‐159, prepared by Elizabeth A. Jones and Richard A.Voorhees, with Karen Paulson, for the Council of the National Postsecondary Education Cooperative Working Group on Competency‐Based Initiatives. Washington, DC: 2002. CBE addresses what the learners are expected to do rather than what they are expected to learn (Savage, 1970). CBE is based on a set of outcomes that are derived from an analysis of tasks typically required at an entry level (Scheck, 1978). The following characteristics of competency based education, derived from Norton, Delker and Foyster (1990), also provide guidance in the development of competency based education programs: • Competencies are carefully selected • Supporting theory is integrated with skill practice. Essential knowledge is learned to support the performance of skills. • Detailed training materials are keyed to the competencies to be achieved and are designed to support the acquisition of knowledge and skills. • Methods of instruction involve mastery learning, the premise that all participants can master the required knowledge or skill, provided sufficient time and appropriate training methods are used. • Participants’ knowledge and skills are assessed as they enter the program and those with satisfactory knowledge and skills may bypass training or competencies already attained. Demonstration of competencies may be provided through various 5 methods including portfolios, evaluation of observed performance such as interviewing skills and physical examination, or various paper and pencil testing. • Learning should be self‐paced. Programs will vary on the degree of self‐paced learning and advanced placement allowed based on university policies and resources. • Flexible training approaches include large group methods, small group activities, and individual study. All of these approaches are essential components. • A variety of approaches and support materials is necessary, including print, audiovisual, and simulations (models) keyed to the skills being mastered. • Satisfactory completion of training is based on achievement of all specified NP core and population‐focused competencies DNP competency‐based education Enhancing DNP competency‐based education is a priority for NONPF. Many definitions relate to a basic, skill‐focused practice. Historically, nursing education at the basic level prepared a generalist clinician and at the master’s level, the focus narrowed to specialty practice. With the introduction of the DNP, the focus is on development of broad knowledge and skills in inquiry and translation of research. DNP education aims toward achievement in both application of advanced experiential knowledge and generalist knowledge in inquiry that improves health outcomes and quality of care whether through translation of research into practice, performance improvement, or policy revision. Integrated core competencies for NP should reflect this dual and very broad goal, and foster individual’s professional development, expertise, leadership and creativity. In DNP study, evaluation based on competency achievement addresses the needs of practice and takes place in clinical and experiential settings. The evaluation addresses the cognitive, affective and psychomotor skills. The ability to think critically, use theories to solve complex problems, to make inferences, draw conclusions, initiate and evaluate intervention are encompassed in competency based evaluation. Competency‐based evaluation will continue to evolve allowing for individualized rather than prescribed “one size fits all” approaches to learning that can meet the needs of patients, employers and other stakeholders. Consistent with national education standards, the NONPF leadership believes that continual development and refinement of defined competencies is necessary as different roles, diverse populations, and varying environmental context/situations demand a different set of competencies (.U.S. Department of Education, National Center for Education Statistics. 2002). Consequently, this toolkit will be reviewed and revised for currency as new competencies emerge to meet the demands of complexities of societal health needs. Development of competence is a complex process. The National Research Council (2000) stated: Cognitive science research has helped us understand how learners develop a knowledge base as they learn. An individual moves from being a novice in a subject area toward developing competency in that area through 6 a series of learning processes. An understanding of the structure of knowledge provides guidelines for ways to assist learners to acquire a knowledge base effectively and efficiently. Eight factors affect the development of expertise and competent performance: • Relevant knowledge helps people organize information in ways that support their abilities to remember • Learners do not always relate the knowledge they possess to new tasks, despite its potential relevance. This “disconnect” has important implications for understanding differences between usable knowledge (which is the kind of knowledge that experts have developed) and less‐organized knowledge, which tends to remain inert. • Relevant knowledge helps people to go beyond the information given and to think in problem representations, to engage in the mental work of making inferences, and to relate various kinds of information for the purposes of drawing conclusions. • An important way that knowledge affects performance is through its influence on people’s representations of problems and situations. Different representations of the same problem can make it easy, difficult, or impossible to solve. • The sophisticated problem representations of experts are the result of well‐organized knowledge structures. Experts know the conditions of applicability of their knowledge, and they are able to access the relevant knowledge with considerable ease. • Different domains of knowledge have different organizing properties. It follows, therefore, that to have an in‐depth grasp of an area requires knowledge about both the content of the subject and the broader structural organization of the subject. • Competent learners and problem solvers monitor and regulate their own processing, and change their strategies as necessary. They are able to make estimates and “educated guesses.” Competence can be demonstrated in many ways. Examples of how students demonstrate competency include: •
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Portfolio documents to substantiate competencies that link experiential learning to competencies Case studies for discussion that leads to critical thinking for problem solving. Use of objective standardized patient scenarios to demonstrate cognitive and psychomotor skills, and skills in the affective domain (as in Shulman’s Habits of Head, Habits of Hand, Habits of Heart (Gerung, Chick, and Haynie, 2008). Evidence of movement toward expert thinking as seen in clinical reasoning exercises and clinical puzzles. Experiential learning and simulations for application of competencies to both novel and familiar situations Evaluation of a competency should be conducted by everyone affected by the process and outcomes: patients, administrators, clinicians, research mentors, and the student. A tool such as the 360‐degree evaluation allows for a comprehensive assessment in 7 which different parties of interest provide feedback. Evaluation of competency can be demonstrated through the use of portfolio (NONPF, 2007, NP Competency Based Education Evaluation: Using a Portfolio Approach). NP core competencies NONPF’s Domains and Core Competencies of Nurse Practitioner Practice have been used as national guidelines for curriculum development among NP programs since 1990 and remain the basis for evaluating NP practice. The competencies have formed the framework for comparison of educational programs and evaluation of their curricular adequacy. Because core competencies are intended to accurately describe NP behaviors upon entry into practice, periodic review and revision are necessary and ongoing (National Organization of Nurse Practitioner Faculties, 1995; 2000a; 2002; 2006a; 2006b). In response to healthcare complexity and with the movement to DNP degree in 2006, an expert task force led by Dr. Michael Carter developed Doctor of Nursing Practice (DNP) competencies to be used with the Domains and Core Competencies document (NONPF, 2006a; 2006b). All nurse practitioners should be able to demonstrate the core competencies under each of the seven domains listed below. Throughout the competencies, patient is defined as the individual, family, group, and/or community. The core competencies: Domains and Core Competencies of Nurse Practitioner Practice (NONPF, Nurse Practitioner Faculties, 1995; 2000a; 2002; 2006a; 2006b) and the Practice Doctorate Nurse Practitioner Entry‐Level Competencies (National Task Force, 2006) are as follows: DOMAIN 1: Management of Patient Health/Illness Status DOMAIN 2: The Nurse Practitioner‐Patient Relationship DOMAIN 3: The Teaching‐Coaching Function DOMAIN 4 Professional Role DOMAIN 5: Managing and Negotiating Health Care Delivery Systems DOMAIN 6: Monitoring and Ensuring the Quality of Health Care Practice DOMAIN 7: Culturally‐Sensitive Care Additionally, NPs must meet the competencies for their population foci. Competencies for population focus build upon this set of core competencies. With the release in 2008 of the Consensus Model for APRN Regulation, NONPF has adopted the term "population focus" to describe the broad area of preparation for NPs. Previously, NP educators referred to this area of population as specialty. The recognized population foci are: Adult‐Gerontological (Acute Care and Primary Care), Family (Across Lifespan), Neonatal, Pediatrics (Acute Care and Primary Care), Women's Health‐Gender Related, and Psychiatric‐Mental Health. The links below are to the existing competencies for population foci that were developed in a national consensus process. Current efforts will 8 merge and update these competencies, where applicable, to reflect the population foci titles recognized in the Consensus Model for APRN Regulation (2008). •
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Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health. April, 2002 Psychiatric Nurse Practitioner Competencies. 2003 Acute Care Nurse Practitioner Competencies. 2004 Adult Gerontological Primary Care Competencies, 2010 DNP competencies For DNP competency‐based education, DNP competencies for NPs must also be attained. This document addresses specifically the NP Practice Doctorate Competencies (2006) which build on the NP core and population foci competencies. The DNP competencies are organized by the following competency areas: Competency Area: Independent Practice (1) Practices independently by assessing, diagnosing, treating, and managing undifferentiated patients (2) Assumes full accountability for actions as a licensed independent practitioner Competency Area: Scientific Foundation (1) Critically analyzes data for practice by integrating knowledge from arts and sciences within the context of nursing’s philosophical framework and scientific foundation (2) Translates research and data to anticipate, predict and explain variations in practice Competency Area: Leadership (1) Assumes increasingly complex leadership roles (2) Provides leadership to foster interprofessional collaboration (3) Demonstrates a leadership style that uses critical and reflective thinking Competency Area: Quality (1) Uses best available evidence to enhance quality in clinical practice 9 (2) Evaluates how organizational, structural, financial, marketing, and policy decisions impact cost, quality, and accessibility of health care (3) Demonstrates skills in peer review that promote a culture of excellence Competency Area: Practice Inquiry (1) Applies clinical investigative skills for evaluation of health outcomes at the patient, family, population, clinical unit, systems, and/or community levels (2) Provides leadership in the translation of new knowledge into practice (4) Disseminates evidence from inquiry to diverse audiences using multiple methods Competency Area: Technology & Information Literacy (1) Demonstrates information literacy in complex decision making (2) Translates technical and scientific health information appropriate for user need (3) Participates in the development of clinical information systems Competency Area: Policy (1) Analyzes ethical, legal, and social factors in policy development (2) Influences health policy (3) Evaluates the impact of globalization on health care policy development. Competency Area: Health Delivery System (1) Applies knowledge of organizational behavior and systems. (2) Demonstrates skills in negotiating, consensus‐building, and partnering. (3) Manages risks to individuals, families, populations, and health care systems. (4) Facilitates development of culturally relevant health care systems. Competency Area: Ethics (1) Applies ethically sound solutions to complex issues 10 References Gurung, R.A.R., Chick, N.L., & Haynie, A (Eds). (2008). Exploring signature pedagogies: Approaches to teaching disciplinary habits of mind. New York: Stylus Publishing. Mrowicki, L. (1986) Project work english competency‐based curriculum. Portland, OR: Northwest Educational Cooperative. National Research Council (2000). How people learn: Brain, mind, Experience and School. Washington DC: National Academy Press. Norton R.E..(1987). Competency‐based education and training: A humanistic and realistic approach to technical and vocational Instruction. Paper presented in Chiba City, Japan. ERIC: ED279910 Savage, L. (1993). Center for Applied Linguistics. Literacy through a competency‐based education approach. Washington DC: Author. Schneck, E. A. (1978). A guide to identifying high school graduation competencies. Portland, OR: Northwest Regional Educational Laboratory. Page 141‐‐ Approaches and Methods in Language Teaching U.S. Department of Education, National Center for Education Statistics (2002). Defining and Assessing Learning: Exploring Competency‐Based Initiatives, NCES 2002‐159, prepared by Elizabeth A. Jones and Richard A.Voorhees, with Karen Paulson, for the Council of the National Postsecondary Education Cooperative WorkingGroup on Competency‐Based Initiatives. Washington, DC 11 Faculty/Program Resources This section is based on the 2006 DNP NP Competencies. The section will be updated in the future when the new, integrated core competencies for NPs are available. Competency Area: Independent Practice (1) Practices independently by assessing, diagnosing, treating, and managing undifferentiated patients (2) Assumes full accountability for actions as a licensed independent practitioner Outcome Measures Examples of Strategies Sample Faculty/Program Resources The student may demonstrate proficiency by selected areas below: Demonstrates competency by: utilizing advanced clinical decision‐
making that integrates knowledge of pathophysiology, evidence‐based practice, interprofessional collaboration, patient‐centered and cultural factors, and ethical principles to provide coordinated care for a complex patient. Synthesizes knowledge of best practices that enhance quality of care and describes how to negotiate complex health care systems to advocate for patient needs. Demonstrates critical thinking abilities as evidenced through oral and written presentations of cases. 1) Case presentation 2) Analysis of documentation for 12 Community Program: Develops, implements, and evaluates a community program and provides an analysis of its impact on practice. – Experiential learning Plsek, P. (2003). Complexity and the adoption of innovation in health care. Accelerating quality improvement in health care strategies to speed the diffusion of evidence‐based innovation. Agency for Health Care Quality and Research Conference. January 27‐28, 2003. Zimmerman, B., Curt Lindberg, & Paul Plsek (1998). A complexity science primer: What is complexity science and why should I learn about it. Edgeware. Retrieve October 13, 2008 from http://www.plexusinstitute.org/ideas/elibrary.cfm
Complex Case Study Presentation: Presents a case study which demonstrates the ability to independently yet collaboratively manage a complex patient with at Zaccagnini, M. E., & White, K. W. (2010). The doctor of Nursing Practice Essentials: A new model for advanced practice nursing (2nd.ED.). Sudbury: Jones and Bartlett. ISBN 978‐0‐7637‐
7346‐5 Outcome Measures The student may demonstrate proficiency by selected areas below: application of best practice Utilizes a qualitative approach to evaluate his/her clinical experiences and identify themes in his/her advanced practice. 13 Examples of Strategies least 3 major medical co‐morbidities. Standardized Patient Evaluation (real or virtual) 1) Completes a video case presentation 2) Completes appropriate client documentation in written and electronic formats 3) Completes written examination for each case Sample Faculty/Program Resources Chism, L. A. The doctor of Nursing practice. A guidebook for role development and professional issues. Sudbury. MA: Jones & Barlett. Smolowitz, J., Honig, J., and Reinisch, C. (2010). Writing DNP clinical case narratives. Demonstrating and evaluating competency in comprehensive care. New York: Springer Publishing Company. Heinrich, K. (2008). A nurses guide to presenting and publishing. Dare to share. Boston: Jones and Bartlett Publishers. Harris, J. L., Rouseel, L., Walters, S. E., & Dearman, Reflective Practice: C. (2010). Project planning and Management. Provides an in‐depth analysis based on reflection of their clinical practice Sudbury: Jones and Barlett. ISBN978‐0‐7637‐
and patient outcomes during a course 8586‐4 including: Melnyk, B. M., & Fineout‐Overholt, E. (2011). 1) Description of a critical Evidence‐based Practice in nursing and incident that occurred in the healthcare. (Ed. 2nd). Philadelphia: Lippincott, clinical setting including key factors affecting outcome and Williams and Wilkins. impact of their practice on the ISBN 978‐1‐60547‐778‐7 outcome. . 2) Discussion of personal assumptions about clients and Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Sample Faculty/Program Resources how these impact on care. 3) Discussion of clinical decision making and best practice. Competency Area: Scientific Foundation
(1) Critically analyzes data for practice by integrating knowledge from arts and sciences within the context of nursing’s philosophical framework and scientific foundation (2) Translates research and data to anticipate, predict and explain variations in practice Outcome Measures Examples of Strategies Selected Faculty/Program Resources The student may demonstrate proficiency by selected areas below: Agency for Healthcare Research and Quality
Incorporates a philosophy of Evidence‐based practice guidelines: http://www.ahrq.gov/ healing that integrates humanistic Critiques or develops an evidence‐
Barker, Anne M. (2009). Advanced practice values and beliefs. based CPG to address a health care problem related to a national or nursing: Essential knowledge for the profession. Within the practice setting, global health initiative; adapt the Boston: Jones and Bartlett. critically analyzes barriers and guideline to a unique setting or facilitators to interprofessional population with a special focus on Clinical Practice Guidelines http://www.guideline.gov/ communication in order to chronic illness and/or underserved synthesize care processes. populations. Incorporate Cody, W. (2006). Philosophical and Theoretical philosophical and theoretical Perspectives (4th Ed.). Boston: Jones & Bartlett Publishers Evaluates a Clinical Practice underpinnings and synthesize Cooper, Harris. (2010). Research synthesis and Guideline (CPG) for level of knowledge from appropriate meta‐analysis: A step‐by‐step approach. Los utilization in practice and ability to biophysical, genomics, psychosocial, and organizational sciences. improve practice. Angeles: Sage Publications. 14 Outcome Measures The student may demonstrate proficiency by selected areas below: Examines values, beliefs and assumptions guiding advanced practice with individuals, families and a community Contrasts grand theories with middle range theories of nursing Reflects on multiple standards which impact practice within a theory‐based model of quality care Accesses and report on databases of meta‐analyses and synthesized studies Examples of Strategies Clinical Practice Guidelines Develops a plan, grounded in theory and research from multiple disciplines, to implement the evidence‐based CPG within the unique setting or population. Organizational theory or model: Analyze an organization/institution to determine the theory or model that is guiding nursing practice. Identify the evidence that it is being practiced and Determines the strength of how it is impacting practice. evidence needed for clinical practice guidelines Practice Evidence: Compare and contrast what constitutes evidence Synthesizes evidence to answer for nurses, physicians, and patients. compelling clinical questions. Analyze interventions: Select a Designs strategies for ensuring care common intervention utilized in daily is tailored to individual patient practice and analyze the extent in 15 Selected Faculty/Program Resources Dickerson, S.S., & Campbell‐Heider, N. (1994). Interpreting political agendas from a critical social theory perspective. Nursing Outlook 42, 265‐271. Garrard, J. (2007). Health sciences literature review made easy: The matrix method (2nd Ed.). Boston: Jones and Bartlett Publishers Cochrane Data Base Outcome Measures The student may demonstrate proficiency by selected areas below: preferences, values, culture, disease trajectory and spirituality. 16 Examples of Strategies which the intervention is based on solid research findings. If not based on research findings, what is the source for the relevance? Analyze Evidence: Analyzes the strength of evidence available to assist in caring for a population of people with a selected problem. Utilizes a model of evidence‐based practice to organize evidence and plan. Searchable Clinical Question: Formulates an important, searchable clinical question. Conducts a literature search using several sources of meta‐analysis and synthesized studies to collect the best available evidence to answer the clinical question. Presents the findings by strength of evidence and best fit to answer the question. Clinical Practice Guidelines: Make recommendations for clinical practice guidelines, additional studies needed Selected Faculty/Program Resources Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Selected Faculty/Program Resources and next steps in translating these findings into scientifically sound nursing practice. Clinical Change: Develops an idea for a compelling clinical change. Substantiate with evidence. Propose a plan for change. Competency Area: Leadership (1) Assumes increasingly complex leadership roles (2) Provides leadership to foster interprofessional collaboration (3) Demonstrates a leadership style that uses critical and reflective thinking Outcome Measures Examples of Strategies Analyzes a specific incidence of Complex case study: Presents a case interdisciplinary collaboration using study which demonstrates his/her intrapersonal, interpersonal, improvement of interdisciplinary intergroup and/or organizational collaboration on a patient care, attributes organizational or policy issue. Constructs a strategy or strategies to Case Management: Leads a case management team discussion address improving interdisciplinary collaboration in a specific practice demonstrating expert arena. interprofessional communication. 17 Faculty/Program Resources Porter O’Grady, T. , & Malloch, K. (2007). Quantum leadership: A resource for health care innovation. (2nd Ed.). Sudbury: Jones and Bartlett. Olson, E.E, & Eoyang, G.H. (2001). Facilitating organizational change: Lessons from complexity science. San Francisco: Jossey Bass/Pfeiffer. Anderson, L.A. (2001) The change leader's roadmap: How to navigate your organization’s Outcome Measures Evaluates the outcome or describes the most likely outcome of the intervention if implementation is not possible 18 Examples of Strategies Forum Co‐host facilitation As co‐host the student will experience working as in the leadership facilitation role. Students will be graded based on their ability to: a. Co‐facilitate with the faculty on the week assigned to be co‐
host. b. Create questions for discussion based on reading and course objectives c. Monitor and respond to forum postings d. Provide facilitation and scholarly critique e. Post a 1 page reaction to serving as the leader at the end of the week assigned f. Videos: Review and 1 page reaction Interview with Linda A. Hill May 2008 Where will we find tomorrows leader? HBR http://www.youtube.com/watch?v=s
MQmKHmIqY4 Faculty/Program Resources transformation. San Francisco: Jossey Bass/Pfeiffer Sicotte, C., D”Amour, D & Moreault, M (2002). Interdisciplinary collaboration within Quebec community health care centers. Social Science and Medicine 55(6), 991‐1003. Includes tools. Greiner, A.C. & Knebel, E. Editors (2003). Health Professions Education: A Bridge to Quality. Washington DC: The National Academic Press. This is a report from the Institute of Medicine. Bronstein, L.R. (2003) A model for interdisciplinary collaboration. Social Work. 48(3) 297‐306. Howard, E & Teets, J (2005). Electronic nursing notes: A case study on interdisciplinary collaboration. Journal of Educational Technology Systems 34(4447‐459. http://www.britannica.com/ bps/additionalcontent/18/23022203/ Outcome Measures Utilizes critical and reflective thinking to determine strategies one might employ to build on identified 19 Examples of Strategies Interview with Rosabeth Ross Kanter Transforming giants, HBR http://www.youtube.com/watch?v=
WXwroF‐x‐KU&NR=1 Interview with David Kester, cuture of innovation, HBR http://www.youtube.com/watch?v=K
yqHGdIMcas&feature=channel Kiaser‐ communications http://www.kaiseredu.org/tutorials_i
ndex.asp Benefit of teamwork in the health care team‐ A purchase and aownloaded video http://www.kiaseredu/resources Conditions of community health system‐ role in health care reform http://www.kaisernetwork.org/health
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&hc=3117\ Leadership: Presents a seminar analyzing strategies used to develop a leadership career in health care. Faculty/Program Resources Porter‐O’Grady, T & Malloch, K (2007). Quantum Leadership for Health Care Innovation. Sudbury, MA: Jones & Bartlett Publishing. Outcome Measures leadership strengths to assume increasingly complex leadership roles in practice or professional organizations. Evaluates the success of the employed strategies. Examples of Strategies Leadership critique and portfolio development and assessment Evaluates impact of organizational structure, financial and marketing decisions and their impact on the cost, quality and accessibility of health care. Designs, implements and evaluates a quality indicator project to enhance the quality of clinical practice in a complex organization. Demonstrates peer review skills to promote a culture of excellence Complex System Leadership Critique and Change Application ( S Drayton‐
Brooks, 2011) Create an opportunity to examine complex system leadership and change. Identify a leader in the health care system in students system change area of interest. Arrange 2 days to follow this leader and perform 20 Faculty/Program Resources Malloch, K & Porter‐O’Grady, T (2005). The quantum leader: Applications for the new world of work. Sudbury, MA: Jones & Bartlett Publishing. Collins, J (2001). Level 5 leadership: The triumph of humility and fierce resolve. Harvard Business Review. Jan 2001 pp 67‐76 Chinn, P (2004). Peace and power: Creative leadership for building community (6th ed.). Sudbury, MA: Jones & Bartlett Publishing. Health Care Reform bills at federal and state levels. Emergence: A journal of complexity issues in organizations and management at http://www.emergence.org Appalachian Center for Economic Networks (ACEnet) http://www.acenetworks.org See resources from Quality competency Outcome Measures 21 Examples of Strategies Faculty/Program Resources the following critique of leadership, team and system to inform your complex system and change paper. Submit the name, CV and documentation of agreement to shadow the leader. The guidelines are as follows: a. Introduction: Organization and leadership profile and background to support a micro and macro‐analysis) b. Document the vision, mission, goals, objectives, values and philosophies of the leader and system. c. Identify salient structures (organizational, cultural, groups, teams and individuals). d. Examine diversity of perspectives, talents and people e. Critique functions and task, information storage and transmission 1f.. Critique organizational culture and stakeholders g. Examine renewal and evaluation systems h. Identify an area for change within the health‐care system. Apply key concepts of complexity science and a change to recommend a systematic and innovative, evidenced‐based Outcome Measures Examples of Strategies Faculty/Program Resources change plan. Utilize the Change Process Model to illustrate the fullsteam process (Anderson, 2001) . Include a 1 page structural‐process concept map illustrating the system and the plan. Attempt to show attributes, inter‐relations, qualities and patterns in the illustration. Oral presentation to group members. Provide feedback to 3 peers utilizing specific criteria that reflect the impact of the project on clinical practice. Competency Area: Quality
(1) Uses best available evidence to enhance quality in clinical practice (2) Evaluates how organizational, structural, financial, marketing, and policy decisions impact cost, quality, and accessibility of health care (3) Demonstrates skills in peer review that promote a culture of excellence Outcome Measures Examples of Strategies Selected Faculty/Program Resources The student may demonstrate proficiency by selected areas below: Synthesize an analysis of the literature Case: Present a case on a client Quality and Safety Education in Nursing related to quality in a focused area of (written or oral) including a http://www.qsen.org/ advanced clinical practice. discussion of available evidence, evaluation of evidence, and how best Fiandt, K. (2007). Quality improvement for nurse Determine evidence gaps within a evidence was used in client managed health centers. Institute for Nursing practice setting. management. Centers. W.K. Kellog Foundation. www.nursingcenters.org Initiate changes in approaches to care Analysis Paper: Develop an analysis 22 Outcome Measures The student may demonstrate proficiency by selected areas below: when new evidence warrants evaluation of other options for improving outcomes or decreasing adverse events. Perform a systematic review and develop an evidence table that synthesizes the results of 3‐5 key studies supporting an evidence‐based intervention. Compare and contrast the quality and level of the evidence for an existing practice. Recommend ways to acquire data to evaluate the quality of the intervention once implemented in the practice. Demonstrate the ability to locate evidence related to a particular health problem or need. Demonstrate ability to analyze and evaluate evidence to determine best evidence for quality practice. Examples of Strategies Selected Faculty/Program Resources Institute for Healthcare Improvement Model for Improvement www.ihi.org The Dartmouth Center for the Evaluative Clinical Sciences www.clinicalmicrosystems.org Guidelines sponsored by Agency for Healthcare Database Analysis: Access and report Quality and Research on databases of meta‐analyses and www.guidelines.gov synthesized studies. National Quality Measures Clearinghouse Strength of Evidence: Analyze the www.qualitymeasures.gov strength of evidence that influences the provision of care (assessment, Centers for Medicare and Medicaid Services diagnosis, treatment and evaluation) www.medqic.org Strength of Clinical Practice: Improving Chronic Illness Care Determine the strength of evidence www.improvingchroniccare.org needed for clinical practice guidelines Institute of Medicine Quality Improvement: Identify a www.iom.edu quality improvement area in practice National Committee for Quality Assurance and develop a plan for www.ncqa.org implementation, evaluation, and National Quality Forum follow‐up of the plan following the www.qualityforum.org Compare and contrast what constitutes steps in the quality improvement The Academic Center of Evidence‐Based Practice 23 paper regarding the determination of best evidence for a particular health problem or need. Small Group: Work with a small group to determine the best evidence for a particular health problem or need. Outcome Measures The student may demonstrate proficiency by selected areas below: evidence for healthcare providers (i.e. Physicians, Nurse Practitioners) vs. patients related to a specific clinical problem. How does each evaluate quality? How are they the same or different? Examples of Strategies process. Evidence‐Based Practice: Develop Evidence‐Based Practice recommendations to increase quality in a practice setting. System Change: Utilize a framework to introduce broad‐based change in a system. Best Evidence: Lead staff at a clinical site in investigating and determining best evidence for a particular health problem or need. Sources of Evidence: Discuss (via discussion board, journal, blog) clinical situations where you noted that either a nursing/ provider/other healthcare provider intervention/recommendation was not based on solid research findings. What was the source analysis of evidence? Case Study: Present a case study of a situation where the patient makes a decision that contradicts prevailing 24 Selected Faculty/Program Resources at the University of Texas Health Science Center in San Antonio http://www.acestar.uthsca.edu Essential Competencies for Evidence‐Based Practice in Nursing Cochrane Collaborative Library ‐‐ for systematic reviews and a collection of EBP guidelines http://www.cochrane.org/index0.htm Joanna Briggs Institute (JBI)‐for systematic reviews and a collection of EBP guidelines http://www.joannabriggs.edu.au/about/home.ph
p AHRQ Guideline Clearinghouse http://www.guideline.gov/ AHRQ Healthcare Innovations http://www.innovations.ahrq.gov/ Quality Tools: http://www.innovations.ahrq.gov/qualitytools/ National Quality Measures Clearinghouse: http://www.qualitymeasures.ahrq.gov/ Sigma Theta Tau Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies clinical practice guidelines and evidence based practice. Provide a detailed discussion of how the DNP approached the clinical care studies reported in this situation. QSEN related project (S. Drayton‐
Brooks, 2011) 1. Identify a practice guideline of a salient health care problem facing at‐
risk and vulnerable populations such as diabetes, health disease, or another area of interest related to your current practice area 2. Consider the QSEN competencies at url http://www.qsen.org/ksas_graduate.
php and your selected practice guideline answer the following questions in 5 pages: a. How might advanced practice providers integrate quality and safety competencies in the context of health care delivery system b. How might advanced practice providers adapt and develop evidenced based practice guidelines based on relevant clinical studies. 25 Selected Faculty/Program Resources http://www.nursingsociety.org VA/DOD Clinical Practice Guidelines http://www.healthquality.va.gov/ Evidence‐Based Behavioral Practice http://www.ebbp.org/ Centre for Evidence‐Based Medicine: http://www.cebm.utoronto.ca/ Educational Prescriptions: http://www.cebm.utoronto.ca/practise/formulate
/eduprescript.htm Critical Appraisal Worksheets: http://www.cebm.utoronto.ca/teach/materials/ca
worksheets.htm Formulating Answerable Clinical Questions: http://www.cebm.utoronto.ca/practise/formulate
/ Introduction to Evidence‐based Nursing: http://www.cebm.utoronto.ca/syllabi/nur/intro.h
tm DNP Toolkit: University of Washington: http://healthlinks.washington.edu/nurse/dnp Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies c. How can the practice guideline you have selected be adapted or changed to improve quality and safety of care for at‐risk and vulnerable Americans? d. What system structures of care (intrastructure, people that provide care) and processes need to change to meet the goal of safety and quality in health care? Selected Faculty/Program Resources Melnyk , B.M. and Fineout‐Overholt, E. (2005). Evidence‐based practice in nursing and healthcare. A guide to best practice. Philadelphia: Lippincott Williams & Wilkins. Malloch, K. and O’Grady, T. (Eds). (2010). Introduction to evidence‐based practice in nursing and health care. Boston: Jones and Bartlett. Post a ½ page report in the forum and prepare to present and discuss in a group problem‐
solving forum. Analyze a business operations challenge in a present or future work environment using one or more financial concepts/performance improvement concepts. Evaluate the costs and benefits of 26 Decisions Affecting Healthcare: Evaluate how organizational, structural, financial, marketing, and policy decisions impact cost, quality, and accessibility of health care. Financial: Analyze financial Economics website—costing out healthcare Economic benchmarks Finkler, S., Kovner, C. and Jones, C. (2007). Financial management for nurse managers and executives. 3rd Edition. St. Louis: Saunders Elsevier. Outcome Measures The student may demonstrate proficiency by selected areas below: various nursing care delivery models, quality initiatives, and capital projects. 27 Examples of Strategies Selected Faculty/Program Resources statements in order to effectively participate in decision making regarding allocation of resources. Organizational Productivity & Profitability: Develop strategies to enhance productivity and profitability of the healthcare organization Quality Initiatives: Develop and implement quality initiatives to improve clinical outcomes, market position, and financial performance of the healthcare organization. Policy: Follow current major policy discussions at local, state, national, and international level. Determine how policy affects quality. Quality Improvement Plan: Design, implement and evaluate a quality improvement plan. Healthcare company: Select a Cleverley, W.O. and Cameron, A.E. (2007). Essentials of health care finance. 6th edition. Sudbury, MA: Jones and Bartlett Publishers. Marquis, B.L. and Huston, C.J. (2006). Leadership roles and management functions in nursing. 5th edition. Philadelphia: Lippincott, Williams, and Wilkins. Outcome Measures The student may demonstrate proficiency by selected areas below: Compare and contrast the peer review process from at least two different clinical settings. Develop a peer review process for a future practice setting or organization. Demonstrate skills in peer review that promote a culture of excellence, and collegiality. Utilize evaluation process effectively in organizational or practice setting. Examples of Strategies healthcare or healthcare‐related public company and analyze its financial statements. Apply knowledge of trend analyses, ratios, peer comparisons, benchmarks, etc. Peer Review: Complete a peer review and communicate relevant information about strengths and weaknesses in review of peers’ work or presentations. Peer Review: Develop a paper or presentation on the use of peer review including benefits, costs, peer review methods, evaluation of methods, examples of methods used in practice, and recommendations. Peer Review: Demonstrate synthesis and analysis of peer review literature Peer Review: Examine various peer review processes available and determine the appropriateness for the clinical setting. 28 Selected Faculty/Program Resources Resources Paper or presentation course assignment with grading criteria as sample Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Selected Faculty/Program Resources Health outcomes & Costs: Offers alternative suggestions for improving care and health outcomes while reducing cost compared to usual practices. Competency Area: Practice Inquiry (1) Applies clinical investigative skills for evaluation of health outcomes at the patient, family, population, clinical unit, systems, and/or community levels (2) Provides leadership in the translation of new knowledge into practice (4) Disseminates evidence from inquiry to diverse audiences using multiple methods Outcome Measures Examples of Strategies Selected Faculty/Program Resources The student may demonstrate proficiency by selected areas below: Collects and analyzes data for a patient National Standards: Present a population and compares the outcomes comparison of national standards in to national benchmarks outcomes and costs for a patient population. Practice & Policy Change: Discussion of current research with implications for practice change and policy in advanced nursing practice Identifies unmet health care needs in Databases: Accesses existing 29 Outcome Measures The student may demonstrate proficiency by selected areas below: the community using existing public health databases and develops strategies for increasing access to health services to meet these needs Leads a journal club for nurses or participates in an inter‐professional journal club which discusses research related to the selected practice population. Critical analysis of 3‐5 studies in a focused area with evaluation of strengths and weaknesses of methods and synthesis of findings across studies. Proposes a change in practice or policy based on research/evidence for the selected population in the practice site 30 Examples of Strategies Selected Faculty/Program Resources databases and selects relevant data for local comparisons Evidence: Provides evidence to support work in professional organizations. Evidence: Creates an evidence table synthesizing results of 3‐5 studies focused on one area with recommendations regarding usefulness of the findings and how they can be used in practice Practice or Policy Proposal: Develops a proposal synthesizing research/evidence supporting proposed change; identifies Greenhalgh, T. (2006). How to Read a Paper: The basics of Evidence Based Medicine, 3rd Edition. ISBN 9781405139762. BMJ publishing. Bowers, D., House, A., Owens, D. (2006). Understanding Clinical Papers 2ed Edition. ISBN 978‐0‐470‐09130‐2 John Wiley & Sons. Dicenso,A., Guyatt, G., Ciliska, D. (2005).Evidence‐
Based Nursing: A Guide to Clinical Practice. ISBN 978-0-323-02591-1 Elsevier Mosby.
Munro. B.H. (2004). Statistical Methods for Health Care Research (5th ed.). ISBN‐13: 978‐
0781748407. Lippincott Williams & Wilkins publisher. Perera, R., Heneghan, C., Badenoch, D. (2009). Statistics Toolkit. ISBN 978‐1‐4443‐1257‐7 John Wiley & Sons. Outcome Measures The student may demonstrate proficiency by selected areas below: Uses existing data to identify prioritized needs for change with the goal to reduce burdens of illness and disability. Interprets data on health outcomes and develops recommendations that are 31 Examples of Strategies Selected Faculty/Program Resources stakeholders and support for the change; identifies resources needed, potential to reduce costs and improve outcomes; impact of change on current policy and roles; identifies sequence for introducing change and evaluation. Presentation: Public presentation of power point depicting the practice problem, methods of study used and the results with recommendations for practice improvement Utilization of Existing data: Identifies sources of existing data for baseline / needs assessment, use of informatics to maintain a database for practice, teaching about data retrieval, available clinically focused monitoring tools, measurement methods, conducting a focus group to evaluate a practice change. Accesses existing databases in setting/local agency; uses publically available data about population to anticipate needs Systematic Review: Performs a systematic review of the latest Outcome Measures The student may demonstrate proficiency by selected areas below: presented to stakeholders and policy makers. Studies clinical problems at patient groups for which treatment approaches are most effective and less costly Disseminates results of the inquiry project and includes patients, staff and organizational leaders. Uses the results of a clinical inquiry project to change care delivery standards in an area of advanced nursing practice 32 Examples of Strategies research about prevention, diagnosis, and treatment. Professional Presentation: Presents data at local, regional and national professional conferences on outcomes of clinical inquiries Website Development: Develops a Web site that utilizes a research portfolio online reporting tool that increases transparency of this research for the benefit of man. Cost Analysis: Compares various payment incentive models using consultants within a research environment Selected Faculty/Program Resources Practice Improvement: Shares data on quality improvement from inquiry project with professional colleagues. Seeks /uses comparative sources of data to examine similarity of themes and recommendations needed to improve practice. Competency Area: Technology & Information Literacy (1) Demonstrates information literacy in complex decision making (2) Translates technical and scientific health information appropriate for user need (3) Participates in the development of clinical information systems Outcome Measures The student may demonstrate proficiency by selected areas below: Analyzes practice settings to Identify and prioritize problems in the practice setting that can be addressed by the advanced practice nurse. Analyzes the current evidence related to various healthcare topics Demonstrates expertise in the utilization of electronic library resources. Accesses and analyzes financial statements of a healthcare or healthcare‐related public company. Evaluates allocation of resources. Determines areas needing quality improvement within the practice or organization through multi‐disciplinary 33 Examples of Strategies Selected Faculty/Program Resources PICO (T): Identifies and formulates an appropriate PICO (T) question using evidence‐based resources for the practice setting in which care is being delivered.
Level of Evidence: Identifies the levels of evidence utilized in their PICO(T) assignment. Presentation: Presents their PICO(T) project to peers for critique and review and incorporates feedback into the assignment. Systematic Review: See Quality #2 Examples: identifies the number of type 2 diabetics in the practice and whether the guidelines and standards are being met in the management protocol; Examples of general resources related to topic: Quality and Safety Education for NursesFaculty Resources Annotated Bibs Resources from the American Nursing Informatics Association http://nursingandhealth.asu.edu/eviden
ce‐based‐practice/pico.htm Outcome Measures The student may demonstrate proficiency by selected areas below: inquiry(s). 34 Examples of Strategies Evaluates the use of EMR in the organization Electronic Medical Record: Uses data from EMR to identify practice problems and to evaluate outcomes after an intervention Presents a paper demonstrating the ability to analyze financial statements and recommend potential areas of cost savings related to a specific clinical area. Allocation of Resources: Participates in an organizational meeting discussing allocation of resources. Organizational Costs & Savings: Provides analysis of specific costs and potential areas of savings to organization. Allocation of Resources: Incorporates ideas and recommendations from participating stakeholders into plans for allocation of resources in a change project. Selected Faculty/Program Resources Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Gaps in Knowledge or Practice: Identifies a knowledge or practice gap and proposes or implements an intervention focusing on quality improvement addressing the following questions: Is it achievable? How will it change practice/ care delivery/ health outcomes/ quality of care/ quality of life? Are there economic ramifications? Is it economically feasible? Does it improve safety? Are there shared goals? Does it apply to a culturally diverse society? Are there policy implications? Participates in the development of a Healthcare System: Assess the current comprehensive clinical information system. health care organization and identify the types of information that is critical to the Identifies the purposes and need for data Information Systems (IS) project. that can be obtained using clinical information systems Clinical Information System: Create a clinical information system that will Implements decision support programs that focus inputs and the creation of a system are pertinent to practice (clinical guidelines, that can provide output (can be a case or drug interaction checking, etc) and will an evaluation of the current system the student is using). Does the system improve patient outcomes, and patient education. provide the data the HC organization 35 Selected Faculty/Program Resources The American Health Information Management Association: RFI/RFP Template Information on Health Care information Systesm Informatics Review The website of The Informatics Review, an e‐journal of the Association of Medical Directors of Information Outcome Measures The student may demonstrate proficiency by selected areas below: Integrates business strategies to produce a plan to support the development of clinical information systems. Analyzes clinical tracking systems. 36 Examples of Strategies Selected Faculty/Program Resources needs to show quality patient outcomes? Quality & Safety: Incorporate current quality and safety issues related to delivery of care to a population in the HC organization via a case study. Healthcare Organization: Assess the needs of the HC organization, review the current approaches used to address the need, then, develop a change plan based on the needs of the HC organization. Business Plan: Develop a business plan to support the development of a clinical information system or a component of the system. Business Plan: Develop business plan to provide access to decision making tools and guidelines. Decision‐Making: Demonstrate decision making processes that would include Systems. HIMSS (Healthcare Information and Management Systems Society) A searchable site with extensive information on clinical information and decision support systems. Healthcare Information and Management Systems Society The HIMSS site provides information about the organization, educational programs, health industry news, job search capability, a forum for discussion, and links to its journal and an on‐line bookstore. The Electronic Healthcare Network Accreditation Commission This nonprofit group establishes standards for the electronic exchange of health care information. The home page includes links to related information sources. Strategic planning Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies trend analysis, cost benefit analysis, forecasting, and project management. Decision‐Making: Demonstrate decision making processes that would include ability to track productivity. Tracking System: Utilizes a tracking system across the trajectory of their clinical practicum. Tracking System: Utilizes a tracking system for the purpose of carrying out a strategic analysis that would include quality assurance measures, resource management strategies, and project management strategies. 37 Selected Faculty/Program Resources Rapid Implementation of an Electronic Health Record in an Academic Setting EMR Cost‐Benefit Analysis: Managing ROI into Reality The Value Of Electronic Health Records In Solo Or Small Group Practices Competency Area: Policy
(1) Analyzes ethical, legal, and social factors in policy development (2) Influences health policy (3) Evaluates the impact of globalization on health care policy development. Outcome Measures Examples of Strategies The student may demonstrate proficiency by selected areas below: Evaluates the ethical, legal, social and Case Study: Using a case study, the policy issues related to genetic testing. student evaluates the impact of state and federal laws on privacy and confidentiality of genetic test results. Case Study: Using a case study, evaluate the impact of a policy such as the Genetic Insurance Nondiscrimination Act (GINA) on genetic discrimination for an individual undergoing genetic testing. Investigates how the global impact of various health care organizations has affected policy development (ie. American Nurses Association, International Council of Nurses, World 38 Faculty/Program Resources International Society of Nurses in Genetics (ISONG) http://www.isong.org/ Genetic Information Nondiscrimination Act (GINA) http://www.ornl.gov/sci/techresources/Huma
n_Genome/elsi/legislat.shtml Policy statements related to ethical issues in genetics and genomics http://www.kumc.edu/gec/prof/geneelsi.html
#test State genetics privacy laws http://www.ncsl.org/IssuesResearch/Health/G
eneticPrivacyLaws/tabid/14287/Default.aspx Healthcare Globalization: Describe a Globalization and Health: Pathways, Evidence specific example of how globalization and Policy (2009) Edited by Ronald Labonté, of health care has impacted policy Ted Schrecker, Vivien Runnels, Corinne Packer development (ie the globalization of WHO website examples of how genomics has the Cleveland Clinic and changes in impacted health care and policy worldwide. Outcome Measures The student may demonstrate proficiency by selected areas below: Health Organization, etc.) and how organizational policies have had global impact due to the globalization of health care (ie Health Insurance Companies, organizations providing clinical services, etc.). Explains a)The Scope of Practice Partnership(SOPP); b) The Coalition for Healthcare Accountability, Responsibility and Transparency(CHART); and c)The coalition for Patients Rights(CPR) 39 Examples of Strategies policy to attract more overseas patients) Policy and Impact: Write a paper describing the policy, the resulting impact on health care system, and how this has impacted health care. Legislation: Analyze how current or proposed federal and/or state legislation could limit scope of practice of DNPs. Healthcare Reform: Engage in collegial debate on health care reform principles and their effect on advanced practice roles Faculty/Program Resources http://www.who.int/genomics/policy/en/
Devitt, M . AMA Creates “Partnership” to Limit Other Providers ‘Scope of Practice :The Next Attempt to “Contain and Eliminate “ Chiropractic? Dynamic Chiropractic. 2006; 24(12): 1‐7 Palmer, C. ADA, coalition supports health care transparency legislation. Available at http://www.ada.org/prof/resources/pubs/ada
news/adanewsarticle.asp?articleid=1989. Showronek, P. CHART telephone survey‐
Nationwide Survey Shows Widespread Consumer Confusion over Differences Among Health Care Providers. Available at http://earnosethroatassociates.com/entnews archive 0606.html About Us. Coalition for Patients’ Rights(CPR) . Available at: http://www.patientrightscoalition.org/ Joint Statement :Health Care professionals Urge Cooperative patient Care ; Oppose Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Faculty/Program Resources SOPP&AMA Resolution 814. CPR Available at: http://www.patientrightscoalition.org/Joint‐
Statement.aspx Statements of Support. CPR Available at : http://www.patientrightscoalition.org/Stateme
nts ‐of ‐Support.aspx The 5 NP political Issues and the One Solution. NPWN Sept/Oct 2009 Volume 12, No. 9/10 Competency Area: Health Delivery System (1) Applies knowledge of organizational behavior and systems. (2) Demonstrates skills in negotiating, consensus‐building, and partnering. (3) Manages risks to individuals, families, populations, and health care systems. (4) Facilitates development of culturally relevant health care systems. Outcome Measures Examples of Strategies Faculty/Program Resources The student may demonstrate proficiency by selected areas below: Assesses organizations using organizational System Analysis: Paper analyzing a 1. Readings: and systems theories/concepts. microsystem from a systems perspective Borkowski, N. (2009) Organizational Behavior, Theory, and Design in Analyzes system issues within organizations Organizational Change: Paper analyzing a Health Care. MA: Jones and that impact safety, quality improvement, need for change to improve practice Bartlett Publishers. ISBN 13: 978‐0‐
ethical practice and cost effective care. within an organization and applying 7637‐4285‐0 (pbk.) change theory to implement the 40 Outcome Measures The student may demonstrate proficiency by selected areas below: Applies change theory to implement and sustain change in practice delivery. Demonstrates leadership qualities within organization. Articulates the process of practice change within organizations. Analyzes basic business and economic principles and practices, including budgeting, marketing for application to the delivery of health care. Applies ethical principles regarding the delivery of health care in relations to healthcare financing and economics. Develops and defends a project budget within given constraints for an organization. 41 Examples of Strategies improvement. Organizational Change: Participation in an organizational change process to improve health care Organizational Leadership: Lead group meeting to identify and address an organizational issue Practice Leadership: Paper on the role of the NP as a leader in the practice site Case Study: Includes in case (client) presentations the impact of the microsystem on the health care of the client and families. Practice Guidelines: Presentation on the process of implementing practice guidelines within the organization Budget Development: Create an organizational budget for a practice change Healthcare Financing: Develops a paper on the relationship between health care Faculty/Program Resources Gareth, M. (2006) Images of Organization. CA: Sage Publications. ISBN: 1‐4129‐3979‐8 Ford, R. C., Sivo, S.A., Fottler, M.D., Dickson, D., Bradley, K. & Johnson, L. (2006) Aligning internal organizational factors with a service excellence mission, Health Care Management Review, 31(4), 259‐
269. Rivers, P.A., Fottler, M.D., & Parker, M. (2005) Environmental assessment of the Indian Health Service.Health Care Management Review, (30)4, 293‐303. Borkowski, N., & Gordon, J. (2006) Entrepreneurial organizations: the driving force for improving quality in the health care industry. Journal of Health and Human Services Administration, 28(40), 531‐549 Hall, R. H. (1996). Organizations: structures, processes, and outcomes ( 6th ed.) Englewood Cliffs, NJ: Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies financing and the cost of care within the practice organization Organizational Issues: Demonstrated conceptual and analytical skills in evaluating links among practice and organizational issues. Faculty/Program Resources Prentice Hall Miller, D., & Friedson, P. H. (1980). Momentum and revolution in organizational adaptation. Academy of Management Journal, 23(4), 591‐
614. Ruefm M., & Scott, R. W., (1998). A multidimensional model of Organizational legitimacy: Hospital survival in changing institutional environments. Administrative Science Quarterly, 43(4), 877‐904. Institute for Health Care Improvement website ‐ http://www.ihi.org/IHI/. Note: registration is free. Institute for Health Care Improvement White Papers: A framework for Leadership Improvement – February 2006 2. Syllabus available upon request: UNIVERSITY OF PORTLAND SCHOOL OF NURSING NRS 547: ORGANIZATIONAL AND SYSTEMS LEADERSHIP 42 Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies Faculty/Program Resources 3 CREDIT HOURS Doctor of Nursing Practice Program –
Spring 2010 Email: napolita@up.edu 3. University contract information: Post‐Master’s students: Use of own clinical sites (organizations) will necessitate arrangements with program
Post‐Baccalaureate students: Identification and arrangements with organizational sites. Expectations for student outcomes should be clear. Articulates the process of practice change within organizations. Demonstrates leadership qualities within organization Analyzes basic business and economic principles and practices. Demonstrates leadership qualities with in 43 Consensus Building websites Clinical Experience: Participates in a clinical experience that allows student to A Short Guide to Consensus Building ‐ spend time with a chief nursing officer, http://web.mit.edu/publicdisputes/prac
chief executive officer, or other members tice/cbh_ch1.html Resolve consensus building tools ‐ of the executive suite to learn more http://www.resolv.org/tools/ about organizations and systems. Building Consensus ‐ Interdisciplinary Team: Participation in an https://www.msu.edu/~corcora5/org/c
interdisciplinary team change process to onsensus.html improve health care delivery. Outcome Measures The student may demonstrate proficiency by selected areas below: an interdisciplinary team. Demonstrates the ability to adapt the delivery of health care activities to meet the needs individual patients and/or populations. Demonstrates understanding and ability to obtain individual and familial risk factors in multiple areas (physical, genetic, psychological, social, and environmental). Assesses and identifies risks for specific populations. 44 Examples of Strategies Organizational Change: Paper analyzing a need for change to improve practice within an organization. Practice Agreement: Develop an employment contract or practice agreement. Professional Networking: Participate in discussion group on professional networking site such as Linkedin, and uses wikis and blogs. Consensus‐Building: Practice in team building and consensus‐building through interdisciplinary exercises. Risk Assessment: Includes risk assessment with client workups as demonstrated in chart notes and client presentation in clinical seminar. Population Risk: Presents a paper on example of population risk and process to address risk. Faculty/Program Resources Population‐based care websites: Population based care and patient management http://www.thci.org/other_resources/P
opulationCare.htm An Integrated Framework for Risk Management and Population Health Outcome Measures The student may demonstrate proficiency by selected areas below: Articulates process for addressing particular population risk. Demonstrates understanding of risk management. Analyzes risk management program with assigned organization using specific model and concepts. Articulates policy and actions to be taken to reduce risk and improve patient safety within organization Integrates QSEN competencies within risk management assignment. Demonstrate promotion of cultural and linguistic competence as essential approaches in the elimination of health disparities. Generates culturally sensitive health promotion materials Contructs practice protocols which enhance the quality of services within culturally diverse and underserved communities 45 Examples of Strategies Faculty/Program Resources Risk Management: Presents a paper on risk management for organizations as part of quality improvement program. Risk Management: Assesses a risk management program within assigned organization. QSEN: Participates in a group to incorporate QSEN (Quality & Safety Education for Nurses) competencies including those related to NPs into organizational system http://www.encyclopedia.com/doc/1P3
‐1400753121.html Mayo clinic population health site http://mayoclinichealthsolutions.com/p
roducts/products‐main.cfm Evaluation: Evaluates educational materials/programs, practice protocols and health delivery systems with the intent of adapting and applying them to various backgrounds, traditions and ethnicities. Organizational Resources: Constructs organizational resource manuals, policies, and procedures related to service to individuals with language or other communications barriers. Journals Anthropology & Medicine Journal of Public Health Management & Practice Journal of Transcultural Nursing Mental Health, Religion & Culture Nursing Administration Quarterly Patient Education Management Social Science & Medicine 3. Web sites: http://www.diversityrx.org/HTMl/ESLA
NG.htm http://culturedmed.binghamton.edu/ Outcome Measures The student may demonstrate proficiency by selected areas below: Constructs organizational improvement plans based which accommodate a diverse environment Exhibits the ability to adapt the delivery of health care activities to meet the needs and practices of various populations. Examples of Strategies Staff Education: Provides education to the staff related to provision of services to individuals with special needs. Provision of Healthcare: Develops structures that allow consumers and other community members to plan, develop, and evaluate the provision of health care. Possible strategies include conduction focus groups or community participation research. Competency Area: Ethics
Applies ethically sound solutions to complex issues Outcome Measures Examples of Strategies The student may demonstrate proficiency by selected areas below: Identify a ethical delimma in health care Evaluates ethical principles to guide clinical 1. Idenitfy a ethical issue related to your practice. practice change area then identify Ethics Principles: Integrates ethical principles and application of principles in Demonstrates ability to accurately identify clinical decision‐making, discussion of and analyze complex ethical dilemmas in research, clinical and business practice. cases, via presentation, and/ or paper. Analyzes the role of nurse practitioners in 2. Idenitfy a ethical issue related to your 46 Faculty/Program Resources http://www.tcns.org/ http://www.culturediversity.org/links.h
tm School of Nursing to adapt a model for cultural competency. Access to resources for guidance such as Georgetown University cultural competency website Provide faculty with instructional and self‐discovery strategies related to cultural competency. Selected Faculty/Program Resources List sources for standardized clinical ethics cases The Belmont Report (need internet source) Provide case study template that includes ethical issue/s section for application in NP curricula do you have one to share? Outcome Measures The student may demonstrate proficiency by selected areas below: making policy decisions including those that deal with ethical issues. Demonstrate ability to evaluate the ethical credibility of research evidence for application to practice.
Examples of Strategies practice change area then identify Ethical Issues: Develops a plan to address ethical issues in a case involving vulnerable populations. (i.e. children, disabled, elderly, mentally ill, homeless, prisoners) 3. Idenitfy a ethical issue related to your practice change area then identify social justice Develops a plan to address social justice for those in extreme poverty or high risk environments.
3. Idenitfy a ethical issue related to your practice change area then identify Ethics in Research: Utilizes research ethics including human subject selection, informed consent, data management, risk/benefit analysis, the role of the Institutional Review Board (IRB), funded research and authorship and publication issues in evidence based practice research. Ethics Committee: Participates in an Interprofessional ethics committee and provides a written opinion statement with 47 Selected Faculty/Program Resources Article. Peirce, AG & smith, JA (2008). The ethics curriculum for Doctor of Nursing Practice programs Journal of Professional Nursing Sept‐Oct 24(5):270‐74. Textbook Recommendation on Ethics Content: Bosek, M.S. D, & Savage T.A. (2007). The ethical component of nursing education. Philadelphia: Lippincott, Williams & Wilkins. Midwest Nursing Research Society. (2002.) MNRS guidelines for scientific integrity. Available free at www.mnrs.org/files/public/MNRSGuid
elinesforScientificIntegrity.pdf Fowler, M. D. M., Ed. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association. Beauchamp, T. L., & Walters, L. (2008). Contemporary issues in bioethics (7th ed.). Belmont, CA: Wadsworth‐
Thomson Learning. Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies documented rationale stating the specific requirements of a specific project regarding protection of human subjects. NP Role in Ethics: Develops a policy statement discussing the role of a nurse practitioner in the policy and/or ethics committee in an institution. Ethics & Technology: Analyzes a health care issue involving a technological innovation (such as genetic testing, stem cell research, donor organ scarcity, assisted reproduction) for its outcomes for patients, providers, the facility, costs, and the health care system.
Ethics Presentation: Presents a “brown bag” luncheon discussion related to an ethics issue with invited participants within the academicand/or practice communities Ethics Cases: Explains ethical/legal issues within the identified case. Ethical Barriers: Identifies barriers that affect resolution of clinical ethical 48 Selected Faculty/Program Resources Monsen, R. B., Ed. (2009). Genetics and ethics in health care: New questions in the age of genomic health. Silver Spring, MD: American Nurses Association. Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies issue/concern. Ethical Decisions: Applies ethical decision‐making strategies to resolution of a clinical ethical issue/concern. Ethics Cases: Identifies cases that demonstrate key ethical issues common to DNP practice (actual or standardized) Examples of cases: • Decision making at end of life
• Surrogate decision making
Quality of life/sanctity of life Analyzes ethical principles utilized in resolving Interprofessional Discussion: Engages in conflicts of interest in practice management. Interprofessional discussion of ethical issues in complex clinical decision making.
Business Ethics: Identifies, discusses and evaluates business ethics as they apply to advanced practice management including: • coding and billing • HIPAA • risk management • informational technology (EMR, E‐scripts, email) • managed care contracts 49 Selected Faculty/Program Resources Develop clinical case studies examples of managed care contracts, Review federal laws and local regulations related to pharmaceutical and provider relationships. Outcome Measures The student may demonstrate proficiency by selected areas below: Examples of Strategies • continuing education • product sampling • clinical trial funding by pharmaceutical companies Organizational Ethics: Develops a paper/presentation utilizing ethical principles in a case where there is a situation of ‘whistle‐blowing’ and/or in an environment in which taking an ethical stand is risky. 50 Selected Faculty/Program Resources