Student Evaluation in a Concept Based Curriculum Lorraine P. Buchanan, RN, MSN University of Kansas School of Nursing Contact Information Lorraine Buchanan, RN, MSN Clinical Instructor, University of Kansas School of Nursing 913-588-3355 [email protected] 1 Objectives The objectives for this session are: Participants will discuss methods of evaluating a concept in the classroom and the clinical setting. Participants will describe converting traditional classroom and clinical evaluation methods for use in concept-based courses. 2 Classroom- Nurs 338/Nurs 474 N338 is a junior level, second semester nursing course in the KU Undergraduate School of Nursing concept based curriculum, 3 credit hours. N474 is a senior level , first semester nursing course in the KU Undergraduate School of Nursing concept based curriculum, 4 credit hours. Involves teaching Health and Illness Concepts (i.e. Family dynamics, Oxygenation I, Perfusion I, Anxiety) We do NOT teach to a specialty. We are educating a Generalist Nurse. Concept Based Classroom Curriculum As part of the new curriculum, we wanted students involved in their own learning. Key points to remember: Student discover so they will remember and transfer knowledge. Faculty facilitate and guide student. More active learning occurs. Content saturation is minimized. 4 Team Based Learning Tell me and I’ll forget, Show me and I may remember, Involve me and I’ll understand. --Chinese Proverb 5 Concepts for Nurs 332 Health and Illness: Foundations Biophysical Concepts Semester I Nurs 332 – 3 credit hours 1. Health Promotion & Illness Prevention 6. Mobility 7. Comfort 8. Nutrition 9. Tissue Integrity 10. Infection 11. Inflammation 12. Thermoregulation 13. Elimination 15. Sleep Psychosocial Concepts Semester I Nurs 332 – 3 credit hours 1. Clinical Reasoning 2. Interpersonal Relationships 3. Stress & coping 4. Patient Education 14. Self-concept 6 Concepts for Nurs 338 Health and Illness II: Lifespan Semester II Nurs 338 – 3 credit hours 3. Fluid Balance 4. Electrolyte Balance 5. Metabolism 6. Oxygenation I 7. Acid-Base Balance 8. Perfusion I 12. Sensory-Perceptual 13. Fatigue Semester II Nurs 338 – 3 credit hours 1. Human Development 2. Family Dynamics 9. Anxiety 10. Mood & Affect 11. End of Life 7 Concepts for Nurs 474 Health and Illness III: Diverse Populations Semester III Nurs 474 – 4 credit hours 1. Oxygenation II 2. Reproduction 3. Perfusion II 4. Clotting 5. Cognitive Impairment 9. Immune Response 10. Intracranial Regulation 11. Cellular Regulation 14. Genetic Association 15. Sexuality Semester III Nurs 474 – 4 credit hours 1. Addiction 2. Behavior/Temperam ent 3. Abuse 12. Altered Thought Process 13. Spirituality 8 Classroom Concept Delivery Team based learning has five major components for course delivery. They are: Individual Quiz Team Quiz Concept Mini-Lecture Case Involvement- Concept Activity-Adobe Connect Group Discussion-Presentations and ”Huddle” 9 Classroom Evaluation The Concept Based, team based courses have six major components of course evaluation. They are: Individual Quiz score Team Quiz score Peer Evaluation/Attendance points 3 or 4 Exam scores Critical Thinking (Essay) score Standardized Testing score (Practice and Proctored Exam) 10 Adobe Connect Used to evaluate student understanding of concept. Wanted each team accountable for their entry and work on case study. Needed a method that allowed all 16 teams to enter data at the same time=immediate insight. Wanted a way for faculty to monitor team entry. Allows faculty to evaluate understanding and challenge student thinking. Needed to be able to print feedback from case so faculty could use it for a “huddle” or case summary. Individual Case Studies Guide for Case Study Evaluation Adobe Connect Chat for Multiple Case Studies Huddle Worksheets from Chat Use chat to make “huddle” summary worksheets. Huddle worksheets summarize important points of the case studies for the concept. Students use Huddle worksheets to study for the exam. Huddle Worksheet Multiple Choice Exams Each exam covered 3-5 concepts per exam. Included general concept questions + exemplar content questions. Questions assessed understanding of concpet via application and analysis of concept information. Developed using NCLEX style questions 17 Exam Review 18 Exam- Multiple Choice QuestionExample The nurse is planning care for a patient with fatigue from Infectious Mononucleosis. Based on her understanding of this concept, which of the following nursing diagnoses is a priority for this patient? A. Bowel Incontinence B. Ineffective Activity Planning C. Disturbed Body Image D. Activity Intolerance 19 Exam- Multiple Choice QuestionAnswer The nurse is planning care for a patient with fatigue from Infectious Mononucleosis. Based on her understanding of this concept, which of the following nursing diagnoses is a priority for this patient? A. Bowel Incontinence B. Ineffective Activity Planning C. Disturbed Body Image D. Activity Intolerance 20 Exam- Multiple Choice QuestionRationale Rationale: Fatigue in the patient with Infectious Mononucleosis is aggravated by exertion, so the nurse would choose activity intolerance as a priority nursing diagnosis. The patient with this disease will likely not experience bowel incontinence or a disturbed body image. The problem is not that the client is unable to plan activities, but that the patient does not tolerate the activity due to the fatigue from the disease process. 21 Concept Critical Thinking (Essay) Used as part of the final exam to evaluate their comprehensive understanding of the concepts discussed throughout the semester. 25 pts of the approx 500 or 600 point course. See handout for sample. 22 Critical Thinking (Essay) Example 23 Hands-on Activity Pair up with someone. Review the 2 Critical Thinking Exams (Essays) Select Pediatric or Adult Case Study. Try to identify for each question the concept that is being evaluated. Discussion answers as an entire group. 24 Concept List 25 Concepts for Nurs 338 Health and Illness II: Lifespan Semester II Nurs 338 – 3 credit hours 3. Fluid Balance 4. Electrolyte Balance 5. Metabolism 6. Oxygenation I 7. Acid-Base Balance 8. Perfusion I 12. Sensory-Perceptual 13. Fatigue Semester II Nurs 338 – 3 credit hours 1. Human Development 2. Family Dynamics 9. Anxiety 10. Mood & Affect 11. End of Life 26 Concepts in the Adult Essay Sara Jones case had these concepts: Metabolism Anxiety and Mood/Affect Clinical Reasoning * Nutrition * Electrolyte Balance (Calcium) Perfusion I Comfort * Human Development Family Dynamics *Denotes concepts from Health and Illness: I Foundations 27 Concepts in the Pediatric Essay Maggie case had these concepts: Fluid Balance Clinical Reasoning * Electrolyte Balance (Potassium) Acid- Base Balance Oxygenation I Family Dynamics Human Development Patient Education * *Denotes concepts from Health and Illness: I Foundations 28 Moving on to Clinical Evaluation During a comprehensive curriculum revision, faculty developed a plan to scaffold core clinical competencies/concepts through the undergraduate clinical experiences. Eight broad core competencies/ clinical concepts were developed from the QSEN competencies and The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008. 29 KU Clinical Concept Model Quality Improvement Patient Centered Care Evidence Based Practice Safety Competent as a Novice Generalist Nurse Systems Based Practice Informatics & Technology Teamwork & Collaboration Professional -ism Clinical Evaluation How do we evaluate the student in clinical? What is an FLA and DPC? Review evaluation tools. How are the Health and Illness and Professional nursing concepts included and evaluated in clinical? 31 What is a DPC and FLA? DPC= Direct Patient Care FLA= Focused Learning Activity Let’s take a look at some evaluation tools and a few examples of what we use to evaluate the students. 32 Clinical Performance Evaluation Tool PURPOSE: The clinical performance evaluation tool is used to measure the student’s clinical performance as described by the course objectives in the clinical practicum. INSTRUCTIONS: The evaluation tool is used in an ongoing manner as eachstudent progresses through the course. 33 Clinical Performance Evaluation ToolStudent Instructions Student performance is to be monitored by both student and instructor, and behavior documented with supporting comments. The student is responsible for supplying sufficient data for evaluation. The student should seek assistance, guidance and/or consultation of his/her instructor as necessary to evaluate or improve student performance. Students must obtain a satisfactory grade in the DPC and all FLAs to pass the clinical course. The student can only fail an FLA one time and repeat it once otherwise they receive an unsatisfactory in clinical. The student will then have to repeat the clinical practicum next time it is offered. Student and faculty will also complete a mid-term and final evaluation. Conferences will be held at these times to discuss clinical progress and final grade. It is the student's responsibility to attend the mid-term and final evaluation conference prepared to discuss their progress toward meeting the objectives of this course. The student is to initial and date evaluation tool each time he/she reviews the faculty's evaluation 34 Clinical Performance Evaluation ToolRating Key S U NP Satisfactory Student able to meet the criterion Unsatisfactory Student fails to meet the criterion Not Practiced Student has not had the opportunity yet to complete this assignment 35 Clinical Evaluation Tool Sample 36 37 38 39 Clinical Paperwork for DPC 40 DPC Student Guidelines from Playbook 41 Junior Level, 2nd Semester- Lifespan Clinical DPCStudent Instructions • Go to the unit, find your assignment posted and review the EHR of your patient(s) to become prepared for clinical practicum. • Utilize Preclinical Conference patient workup, Laboratory/Diagnostic Tests, Medication Information sheets to guide this preparation. • Bring completed preparation forms to pre-conference on the clinical day. This will guide you in your presentation to faculty. The faculty may ask to review them. • At end of each clinical day of DPC, complete reflection in the on-line Reflective Practice Journal (ANGEL Nurs 339 Health and Illness: Nursing Across the Lifespan Practicum). There are different reflection questions for the first part of clinical (prior to spring break) and the last part of clinical (after spring break). 42 Clinical Grade Profile ToolInstructions Grade Determination for Clinical Performance Students must complete all assignments with either “proficient”, ”satisfactory” or a grade of 80% to pass this clinical course satisfactorily. The student may repeat an assignment only once to achieve the satisfactory standard. Inability to complete any assignment satisfactorily in two tries indicates failure of the course. If a student demonstrates unprofessional behavior or delivers unsafe patient care, the NURS 333 clinical faculty will discuss the student’s situation with the Clinical Coordinator and make a decision regarding the student’s status in the clinical course and grade. 43 Clinical Grade Profile Tool Sample A grade of 80% must be obtained on this component of the Clinical Grade Profile to pass this course satisfactorily. *FLA: Focused Patient Assessment & Care Plan __________ A grade of “Proficient” or “Satisfactory” must be obtained on these components of the Clinical Grade Profile to pass this course satisfactorily. Direct Patient Care (DPC) __________ FLA: Pump Lab __________ FLA: Interdisciplinary I-SBARR Lab __________ FLA: Safety Simulation-Sam Jayhawk & James Robinson __________ *FLA: Change Intervention __________ *FLA: Focused Assessment __________ *FLA: Medication Administration Observation __________ *FLA: Intraprofessional Team Member Interview *FLA: Evidence-based Practice __________ __________ __________ *FLA: Therapeutic Communication-Process Recording *Print and bring all of these FLAs to each clinical experience because the clinical environment is dynamic and you need to be prepared to do other learning activities besides the one assigned that day. 44 Senior Clinical Evaluation Tool Sample 45 46 47 Senior Level- 2nd semester- Diverse ClinicalFLAInterdisciplinary Team Conferences/Rounds 48 Senior Clinical Evaluation Tool 49 Senior Level – 2nd semester- Diverse Clinical- FLAInterdisciplinary Team Conferences/Rounds- Grading Rubric Competency Attends team rounds during time in clinical practicum. Identifies all team members participating in team rounds Identifies team members who evaluate patient outcomes but could not attend team rounds Identifies nurse’s contribution to the team Assumes nurse’s role in team meeting at least twice during rotation Satisfactory Attends 80% of team rounds. Unsatisfactory Attends 50% or less team rounds. Accurately identifies most team members and requires no prompting. Identifies many other team members who could contribute to the evaluation of patient outcomes and requires no prompting. Unable to identify most team members; or requires significant prompting. Identifies a few team members who could contribute to the evaluation of patient outcomes or needs significant prompting. Discusses nurse’s role in team rounds with no prompting. Assumes nurse’s role in team rounds at least twice during rotation and requires no prompting. Unable to identify nurse’s role in team rounds or requires significant prompting. Unable to assume nurse’s role in team rounds without significant prompting. 50 Student Reflection Questions Who led the team conference? Identify any differences in how individual team members talked to the team leader (authority gradient)? What outcomes were being monitored? What would you change about your performance during the team conference/rounds in preparation for the next time you participate? 51 Course-Senior Level- 2nd semesterPopulations-Based Clinical- FLA Physical/Social Determinants of Health for a PopulationGrading Rubric Behavior Satisfactory Unsatisfactory Collects comprehensive data when assessing a target population and includes windshield survey and key informant interviews. Identify key environmental/social health issues of assigned population Completed windshield survey form with accurate comprehensive data of target population. Lists the key informants to the interview Identified 3 key environmental or social health problems from the environmental/social assessment or windshield survey assignment. Adequately described resources and strengths of assigned population to address identified environmental health needs. Windshield survey does not accurate reflect population data or is incomplete. Key informants were not utilized in data collection. Identified environmental health problems that did not relate well to assigned population. Described two community strategies to address identified environmental/social health issue. Does not thoroughly describe strategies to address identified environmental/social health issue. Determines resources and strengths within assigned population to address identified environmental/social health issues Recommends two strategies to address the identified health issue 52 Did not adequately describe resources and/or strengths of assigned population to address environmental health issues. Course-Senior Level- 2nd semesterPopulations-Based Clinical- FLARecommendations for Clinical Instructor: This will be assigned during the first rotation. The faculty will assign students to care for patients on DPC days. These are the patients that the student will watch or participate in team rounds with. Inform the nurse assigned to the patient that the student is expected to attend team rounds. Schedule the last two DPC days for the student to participate in the team rounds. Student may participate more than the last two days.Attend the rounds or obtain nurse’s feedback about the student’s performance in team rounds. 53 Questions?