Fac Clin Judg of APNs.ppt


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  • Although my talk was on the research colloquium schedule, I am actually applying for a position as a practice professor
  • I’m currently in the process of revising and updating the procedures for the AACN procedure manual
  • Member of the committee that studied the practice of acute and critical care nursing throughout the continuum of nursing – from new to practice RNs thru APNs and was selected to take the lead on authoring the findings related to the APN roles.
  • Solid experience with developing and revising curriculum at both the undergraduate and graduate levels. I also worked on writing the grant for the NA program as well as other grants that we not funded.
  • Relationship I have with my students as helped my abilities to develop a preceptor network, not only with our grads, but with their colleagues as well.
  • Will transition here to Teaching Philosophy
  • Since the practice professor’s main focus is on teaching I thought I would tell you my philosophy – which is still being developed and refined.
  • Nurse Practitioner and Nurse Anesthesia students participated in the study comparing face-to-face case study analysis to simulation-based case study analysis
  • The California Critical Thinking Skills Test includes induction, inference and analysis as elements of critical thinking
    In Garrison’s Five Stages of Critical Thinking, it is said that individuals predominantly use the elements of induction, inference and analysis in the problem exploration stage
    The Critical Thinking Coding Form was based on Garrison’s Five Stages of Critical Thinking
  • 34 questions (CCTST Form 2000); Possible Total Score was 34; sum of analysis, inference & evaluation scores
    5 sub scores:
    Analysis – ability to identify intended and actual inferential relationships - 9,
    Evaluation – determine credibility and logical strength of the inferential relationships - 14
    Inference – identify and secure elements needed to draw reasonable conclusions - 11
    Deduction – reasoning from general to the specific - 16
    Induction – reasoning from the more specific to the general - 14
  • All sessions were audio and video taped.
  • Garrison’s stages are consistent with the definition of CT – providing the systematic approach to solving a problem
  • Individual group scores were calculated and compared using the t test for independent samples – Found no significant findings in or between groups, so analyses at the individual and composite levels were performed.
  • Inference is used in the evaluation subscore of the CCTST
  • Problem exploration is when the students are considering the information they have gathered and developing differential diagnoses
    Integration is when the student is able to take the information from this case and see how it fits in the context of other patients or all patients.
  • Referring back to the qualifications of a practice professor
    Any questions??
  • Fac Clin Judg of APNs.ppt

    1. 1. Facilitating Development of Clinical Judgment in Advanced Practice Nurses Deborah Becker RN, PhD, ACNP-BC Advanced Senior Lecturer Program Director, Acute Care Nurse Practitioner Program and Clinical Nurse Specialist Option
    2. 2. Objectives • Review the qualifications for the Practice Professor • Describe Acute Care Expertise and Teaching History • Discuss Teaching Philosophy, Pedagogical Approaches and Strategies • Illustrate How Teaching Approaches are Applied to the Acute Care Nurse Practitioner Program and Clinical Nurse Specialist Option • Describe Future Plans for the Acute Care NP and CNS Programs & my role at the SON
    3. 3. Definition of the Practice Professor • Individuals holding the rank of Practice Professor in the School of Nursing – will participate in educational programs on a full-time basis; – have a high level of educational achievement and relevant practice experience commensurate with the level of appointment; and – shall staff courses related to the scientific application of clinical knowledge in the practice of nursing
    4. 4. Acute Care Expertise • 24 years of nursing experience – all in acute/critical care areas • Remain current by: – Attending classroom presentations by experts – Providing clinical supervision to students – Attending Conferences such as Trends in Critical Care and National Teaching Institute, of the American Assoc. of Critical Care – Presenting on clinical topics at conferences, in undergraduate courses and other NP programs
    5. 5. Acute Care Expertise Becker, D. (in press). Central Line Insertion Procedure. In ACNP Skills and Procedure Toolkit, NONPF Acute Care SIG manual. Becker, D.E. (in press). Temporary Transvenous Pacemaker Insertion. In Lynn- McHale, D & Carlson, K. (Eds.) AACN Procedure Manual for Critical Care, (2nd Ed) (pp. 340-361). Philadelphia: W.B. Saunders. Becker, D.E. (in press) Arterial Line Insertion. In Lynn-McHale, D & Carlson, K. (Eds.) AACN Procedure Manual for Critical Care, (2nd Ed.) (pp. 445-450). Philadelphia: W.B. Saunders. Becker, D.E. (in press) Performing a Pericardiocentesis. In Lynn-McHale, D & Carlson, K. (Eds.) AACN Procedure Manual for Critical Care, (2nd Ed.) (pp. 281-288) Philadelphia: W.B. Saunders. Becker, D.E. (in press) Assisting with a Pericardiocentesis. In Lynn-McHale, D & Carlson, K. (Eds.) AACN Procedure Manual for Critical Care, (2nd Ed.) (pp. 289-295) Philadelphia: W.B. Saunders. Becker, D.E. (2007). Cardiovascular Anatomy & Physiology and Physical Assessment. In Kaplow, R. & Harding, S. (Eds.) Critical Care Nursing: Synergy for Optimal Outcomes. Boston: Jones & Bartlett Publishers.
    6. 6. APN Role Expertise • Keane, A. & Becker, D. (in press). Emerging Roles of the Advanced Practice Nurse. In L. Joel (Ed.) Advanced Practice Nursing: Essential for Role Development, 2nd ed. Philadelphia: F.A. Davis Company. • Becker, D., Kaplow, R., Muenzen, P., & Hartigan, C. (2006). Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical Care Nurses Study of Practice. American Journal of Critical Care, 15(2), 130-148. • Richmond, T.S. & Becker, D.E. (2005). Creating an Advanced Practice Nurse-friendly culture: a marathon not a sprint. AACN Clinical Issues, 16(1), 58-66. • Becker, D.E. & Richmond, T.S. (2003). Advanced practice nurses on acute care services in Mezey, MD, McGivern, DO, & Sullivan-Marx, EM. (Eds.), Nurse Practitioners: Evolution of the Advanced Practice Nurse (4th Ed.). (pp. 135-148). New York: Springer.
    7. 7. Teaching Experience at the SON • Clinical faculty, Course Assistant & AHI Seminar Leader in N370/371 working with K. McCauley • Health Care Lab Instructor - Created Critical Care Modules • Asst. Program Director of the CCNP program – Worked with T. Richmond & R. Watts to coalesce CCNP & TNP programs into the ACNP program • Developed Nurse Anesthesia program offering with A. Keane – Co-Project Director – Nurse Anesthesia Advanced Education Nursing Grant – HRSA Grant Award 2004-2007 – 35% effort; 2006-2007
    8. 8. Teaching Experience • Coordinated Hadassah University MSN Student Immersion Experiences • Coordinated Clinical Immersion Experiences for nurses from the National Neuroscience Institute of Singapore • Visiting scholar in Ireland on practice issues in March 2007 – “Diagnostic Algorithms” Advanced Nurse Practitioner Program, University College of Dublin, Dublin, Ireland, March 2007 – “Comparing the Roles of Nurse Practitioners: Ireland versus United States; University College of Dublin, Dublin, Ireland, March, 2007 – “Comparing the Roles of Nurse Practitioners: Ireland versus United States; Nursing Department, St. Vincent’s Hospital, Dublin, Ireland, March, 2007
    9. 9. Current Teaching Load N 764 – Advanced Technology and Clinical Decisions in Acute Care N 765 – ACNP Role and Clinical Practicum I N 766 – ACNP Role and Clinical Practicum II N 767 – ACNP Role and Clinical Practicum III N 770 – Clinical Nurse Specialist Clinical II (new offering)
    10. 10. Program Leadership ACNP Program & CNS Option • ACNP program and CNS Option are considered top programs in the country • Provide leadership in moving the curriculum forward & maintaining a leading edge related to practice • Keep abreast of accreditation and certification issues affecting the program and graduate’s ability to practice – Representative for American Association of Critical Care Nurses, Work Group for Overlap of Primary Care and Acute Care Competencies, June 2008 • Recruit students for programs at local and national conferences
    11. 11. Program Leadership ACNP Program & CNS Option • Advise prospective students, current students and alumni • Developed preceptor network and continue to increase number of preceptors available to program • Network with other ACNP and CNS program directors to maintain awareness of practice, education and certification issues • Proposed a stand alone CNS program that is going to Senate for vote in October
    12. 12. Role in National Organizations • Co-Chair, ACNP Task Force for Employment and Role Resources for New ACNPs, American Assoc. of Critical Care Nurses, 2007-2009 • Reviewer, American Association of Critical Care Nurses (AACN) Standards for Acute and Critical Care Nursing Practice, 2007-2008. • Chair-elect, ACNP Special Interest Group, National Organization of Nurse Practitioner Faculty, 2007-2008 • Chair, Acute Care Nurse Practitioner Test Specification Task Force, American Association of Critical Care Nurses Certification Corporation 2005-2006 • Chair, ACNP Standards & Scope of Practice Task Force, American Association of Critical Care Nurses 2004-2005
    13. 13. Presentations at National Conferences Becker, D. "How Effective Are We Being: The Role of Simulation in Evaluating Students and Our Teaching?," Poster presentation, The 34th Annual Meeting of the National Organization of Nurse Practitioner Faculties, Louisville, KY, April, 2008. Abraham, D., Becker, D. & Iorianni-Cimbak, A. The Role of Simulation in Evaluating Students and Teaching: How Effective are we? Juried Session, Technologic Innovations in Nursing Education: Best Practices In Informatics & Simulation Conference, Hilton Head, SC, March, 2008 Dubendorf, P., Becker, D. & Pawlow, P. Coming Full Circle: Preparing The Next Generation of Clinical Nurse Specialists, poster presentation, National Association of Clinical Nurse Specialists Annual Conference. “Clinical Nurse Specialists: Leaders in Clinical Excellence”, Atlanta, GA, March, 2008. Becker, D. “Key to Fostering Preceptor Relationships – Unlocking the Mystery” Acute Care Nurse Practitioner Special Interest Group Symposia National Organization of Nurse Practitioner Faculty Annual Meeting, Denver, Colorado, April 2007
    14. 14. Teaching Philosophy • I can’t make anyone learn who doesn’t want to BUT anyone can learn • Learning is a cooperative experience – need a willing student and an instructor who can motivate • Provide a multisensory, social and emotional environment for learning • Provide opportunities for students to practice what they have learned – simulations or case study applications
    15. 15. Pedagogical Approach •Constructivism – Establishing a foundation of knowledge and building upon it as student progresses through program •Providing scaffolding – supportive activities that allow students to build knowledge where their deficits lie •Incorporate simulation to provide students with opportunities to practice skills and clinical judgment without putting patients at risk
    16. 16. Simulation and the Development of Critical Thinking/Judgment Skills Doctoral Dissertation: The Effect of Patient Simulation on the Critical Thinking of Advanced Practice Nursing Students
    17. 17. Purpose Statement To determine the effect of patient simulation on the critical thinking of advanced practice nursing students engaged in case study analysis, as compared to those participating in face-to- face sessions.
    18. 18. Critical Thinking Systematically assessing a situation to identify key components; applying domain specific principles learned from similar situations to determine the best approaches to implement in an effort to improve the situation while evaluating and adjusting the plan as needed In the case of advanced practice nursing, the goal is to improve the patient’s health status & obtain the best possible outcome
    19. 19. Case Study Sessions 128 Participants were randomly assigned to: Simulation method Face-to-Face method AND Case A – cardiac focused case Case B – pulmonary focused case
    20. 20. Critical Thinking Questions • Salient aspects of the case; What additional information would you want to know about this case? • List of top 5 differential diagnoses based on the patients symptoms • What is your priority care issue and Why • Based on the priority issue, what top 5 interventions and rationales for them • Describe the evaluation process to determine effectiveness of your therapy
    21. 21. Critical Thinking Coding Form • Adapted from Kamin, O’Sullivan, Younger & Deterding (2001) • Based on Garrison’s Stages of Critical Thinking: problem identification, problem description, problem exploration, applicability and integration • Used to code behaviors and associated discourse that occurred during case study sessions • Behaviors and discourse were coded as either deep – contributing to solving the problem or superficial – performed but not beneficial to the situation
    22. 22. Problem Identification Imparting New Information – Offering new problem-related information (d) – Repeating information that has already been said (s) – Asking for information not provided yet (d) – Complaining or repeatedly asking for information that cannot be provided (s)
    23. 23. Problem Exploration Linking facts or ideas (d) Repeating information without making inferences or offering an interpretation or stating that one shares the ideas or opinions stated without elucidating or adding any personal comments (s) Interpreting the data or the text material (d) Interpreting the data or the video material (d) Complaints about technology with regard to the text, video, and computer (s) Guiding or focusing the group by synthesizing where the group is or what they need to do, asking about reasoning, and asking probing questions (d) Asking closed-ended questions that require rote memory skills thereby ending critical thinking process (s)
    24. 24. Data Analysis Deep CT and Superficial CT scores were computed for each category of CT for each subject A ratio between Deep and Superficial was calculated for each category; if the ratio was greater than 0.00 – more deep critical thinking occurred than superficial Analysis of equality between means Face to Face vs SIM Problem exploration deep CT ratio: t value = -2.866 p<.005 Integration deep CT ratio: t value = -3.026 p<.004 Interpretation: simulation increases the critical thinking in both the problem exploration and integration stages of critical thinking
    25. 25. Data Analysis Linear regression analysis was performed entering: GPA, yrs of nursing experience, gender, age and method – – Method was found to be statistically significant predictor of critical thinking –specifically simulation generated more critical thinking than the face to face method (p<.01) Sim method was found to be statistically significant coefficient for INTDCT (integration deep CT) (p<.05)
    26. 26. Study Contributions The evidence suggests that patient simulated approaches to clinical problem solving fostered deep critical thinking activities The two areas where this was apparent were problem exploration and integration stages Because the tools used are based on a similar construct of critical thinking, the results are more robust
    27. 27. Implications for Clinical Practice Some support exists for the use of simulated clinical scenarios as a means of providing opportunities for students to think through situations they may later encounter in clinical practice This study has provided additional empirical evidence supporting the use of simulation during problem- based learning case study analyses to enhance the critical thinking, especially during the problem exploration phase in which APNs formulate creative solutions to the problem, link ideas and make assumptions
    28. 28. Current Practice in ACNP Program • Simulation has been incorporated into the Clinical Decisions and Advanced Technologies in Acute Care course to: – Evaluate student’s cognitive ability to: • interview and examine the patient; • Develop differential diagnoses • Develop a working list of top diagnoses • Order, perform and interpret lab studies and studies • Determine most likely diagnoses • Examine the impact of technology on specific patients
    29. 29. Future of the ACNP Program Trends in certification are to include a “practice” competency dimension to the process Plan is to: – Develop terminal objectives that will be evaluated through the use of simulation – Add into each clinical course and as terminal activity Challenge is to determine what to do with students who do not perform well
    30. 30. Current Practice in the CNS Option Technologies such as Blackboard, discussion boards, & chat rooms are currently used Case study analyses are incorporated to assist students development and implementation of the role Assignments included assist students in applying principles to real clinically-based situations
    31. 31. Vision for My Role at the SON Continue to direct Top Ranked programs Increase the use of technology especially simulation in both undergraduate and graduate educational offerings Perform educational research to determine our effectiveness outcomes Publish on educational strategies that highlight our accomplishments Increase the faculty’s knowledge of teaching technologies/strategies Mentor faculty in infusing teaching strategies and technology into their curriculum
    32. 32. My Personal Goals Develop greater content expertise in the use of simulation and technologies Continue to grow my knowledge and use of new teaching strategies Provide leadership and advice in curriculum development and implementing our educational mission Collaborate with top educators nationally and internationally to conduct educational research
    33. 33. Summary • I participate in the education of acute care nurse practitioners and clinical nurse specialists on a full-time basis; • I coordinate and teach in courses related to the scientific application of clinical knowledge in the practice of nursing specific to acute and critical care nursing • I have a high level of educational achievement and relevant practice experience as evidenced by my publications; local, national and international presentations and the committee work I do in national organizations such as AACN, NONPF and SCCM.