Competency for Entry into Practice Utilizing Human Patient Simulation Outcomes and Summary Linda J. Kobokovich, PhD, RN Director of Nursing Practice & Administration Co-Director Nurse Residency Program

Evaluation of Processes and Outcomes

 Quantitative Measures – Simulated Structured Clinical Scenario Performance Evaluation (SSCS) – Self-efficacy for practice - revised – Level of competence – Level of confidence – Readiness for independent practice – Length of orientation

Evaluation of Performance - SSCS

 Simulated Structured Clinical Scenario Performance Evaluation (SSCS) – Attitudes/behaviors – Technical skills/competency – Intellectual skills – Interpersonal skills

NRP: Performance Outcomes

 Performance evaluations demonstrate: – a consistent pattern of increased proficiency and confidence – an ability to “think on the fly” – utilization of resources to problem solve complex or difficult clinical situations.

Self-Efficacy for Practice

  Measured with “Nurse Resident’s Readiness for Entry-into-Practice Competence Questionnaire.” 53-item scale – adopted from Self Efficacy for Professional Nursing Competencies Instrument (Babenko Mould, Yolando et. al) Journal of Nursing Education – April 2004, 43 (4), 149-155.

Self-Efficacy for Practice

 Components – Nurse/client relationship (5 items)  “use therapeutic communication techniques” – Illness/injury prevention (5 items)  “identify actual or potential safety risks to client” – Curative/supportive care (43 items)  “collect data from appropriate sources”  “intervene in a rapidly changing health situation”

Self-Efficacy for Practice

    Alpha = 0.98 (n = 44) Mean at baseline = 72.75 (SD = 10.95) Mean at midpoint = 77.21 (SD = 9.90) Mean at final = 86.44 (SD = 9.10)  Paired t-test (b-f) = -8.444, Sig. <.001

Self-Efficacy for Practice: Discussion

Most significant changes in scores occur in items related to  the use of technology in providing nursing interventions,  synthesizing clinical data, and  making clinical decisions in rapidly changing health situations.

 physiological integrity (MI, respiratory distress),

Self-Efficacy for Practice: Conclusion

 The revised self-efficacy tool demonstrates promise in measuring competency and readiness for entry into practice.

 The curative/supportive care component appears to be the most sensitive.

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Level of Confidence, Competence, and Readiness for Practice: “Global”

Each presented as a 10 mm visual analog scale. At first week and last week, nurse residents rate their level of confidence, competence, and readiness for practice: – “Rate your level of CONFIDENCE to independently provide nursing care to patients with symptoms of the disease processes or clinical situations you studied this week.” – “Rate your level of CONFIDENCE to independently provide nursing care on your unit.” – “Rate your level of READINESS to independently provide nursing care on your unit .”

Level of Confidence, Competence, and Readiness for Practice: “Global”

 Mean at Baseline  Mean at Final  Confidence = 3.20 (SD = 2.24)  Confidence = 7.43 (SD = 1.44)  Competence = 3.75 (SD = 1.90)  Competence = 7.29 (SD = 1.37)  Readiness = 3.55 (SD = 2.17)  Readiness = 7.54 (SD = 1.46)

Level of Confidence, Competence, and Readiness for Practice: “Global”

Paired

t

-test t df Sig. (2 tailed) 1 – Global Confidence 2 – Global Competence 3 – Global Readiness -10.36

37 -10.29

37 -9.69

37 <.001

<.001

<.001

Global Scores at baseline, midpoint, and final for 3 groups

12 10 8 4 6 4 2 8 0 -2 N = 11 11 11 8 Feb 8 8 16 12 14 39 7 7 7 7 April 7 7 GROUP 26 26 26 23 23 23 July baseline global conf idence baseline global comp etence baseline global read iness final global confide nce final global com pete nce final global readine ss

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Level of Confidence, Competence, and Readiness for Practice: “Weekly”

Each presented as a 10 mm visual analog scale. Weekly, nurse residents rate their level of confidence, competence, and readiness for practice: – “Rate your level of CONFIDENCE to independently provide nursing care to patients with symptoms of the disease processes or clinical situations you studied this week.” – “Rate your level of CONFIDENCE to independently provide nursing care on your unit.” – “Rate your level of READINESS to independently provide nursing care on your unit .”

Level of Confidence, Competence, and Readiness for Practice: “Weekly”

Paired

t

-test t df Sig. (2 tailed) 1 – Weekly Confidence 2 – Weekly Competence 3 – Weekly Readiness -7.21

24 -6.33

-4.69

24 12 <.001

<.001

<.001

Weekly Confidence, Competence and Readiness

7 6 8 Mean Confidence Scores by Week 5 4 3 CONF1 CONF2 CONF3 CONF4 CONF5 CONF6 CONF7 CONF8 CONF9 CONF10 7 6 8 Mean Competence Scores by Week 5 4 3 COMP1 COMP2 COMP3 COMP4 COMP5 COMP6 COMP7 COMP8 COMP9 COMP10 8 7 6 Mean Readiness Scores by Week 5 4 3 READY1 READY2 READY3 READY4 READY5 READY6 READY7 READY8 READY9 READY10

NRP: C/C/R Outcomes

 There is consistent improvement in confidence, competence and readiness for practice for recent graduate nurses who participate in the Nursing Residency Program.

Length of Orientation

   Medical/Surgical Track – Median: 14.74 weeks – Range: 9.7 – 19.43 (outlier = 24) Special Care Areas – Median: 14.68

Critical Care – Median: 26.47

ICN: 34 (outlier = 18) PICU: 22 ICU: 22 - 26

NRP: Length of Orientation Outcomes

  Nurse residents complete orientation in a consistent time frame, based upon area of practice Anecdotal decrease in length of orientation

Evaluation of Process and Outcomes

 Qualitative Measures – Feedback from clinical/administrative leadership  Clinical nurse specialist, unit-based educator, unit leaders, or department directors.

– Feedback from participants  Evaluation of didactic content  Evaluation of each laboratory experience for clinical pertinence.

Feedback from Unit Leadership

 Nurse residents: – more predictably take full patient assignment, – come prepared with skills previously missing, – early detection of performance concerns and can support learning earlier and more effectively.

Evaluation of Simulated Experiences

   Should SSCS be part of residency program?

Yes – 96.5% No - 4.4%

Has the SSCS and related content been helpful?

Yes – 98.7% No - 1.8%

Has the SSCS helped you develop your confidence

Yes – 94.7% No - 6.1%

Evaluation of Simulated Experiences

  96.5% of respondents rated SSCS session as “very good” or “good.” 78.5% would like additional or more advanced simulation training.

NRP: Nurse Resident Feedback

  “… it helped me to get over my nervous feelings related to an emergent situation. It also helped to remind me to check and double check.” “Great hands-on learning experience. The scenarios force you to think through the situation and make a judgment. This is a great way to put what we have learned into practice.”

NRP: Program Outcomes

 A structured residency decreases orientation and increases clinical productivity.

 Preceptors and unit leadership report an increased readiness for practice and a more consistent process for the acquisition of skills  Residents report the importance of utilizing resources and can effectively identify and access appropriate resources.

NRP: Program Outcomes - HPS

 Human Patient Simulation helps supports realistic assessment of clinical confidence and competence and readiness for practice in a specific clinical setting.

 Human Patient Simulation provides opportunities to assess not only performance and competence, but more importantly attitudes and behavior.

Concerns about Recent Graduates

      Lack of experience in medication administration (IVs, IV push medications) Calculations of any type Medical versus surgical asepsis Assisting with procedures Managing emergencies Readiness to learn more