Amy Barton, RN, PhD Gail Armstrong, RN, ND Gayle Preheim, RN, EdD, CNAA BC, CNE

1. At the COPA…Looking at QSEN and Competency Outcomes Performance Assessment ModelsUniversity of Colorado Denver College of Nursing Amy Barton, RN, PhD Gail Armstrong, RN, ND Gayle Preheim, RN, EdD, CNAA BC, CNE

2. New Academic Year, New Campus, New School Name, New Curricular Paradigm

3. Where do we want to go, and what have we learned from our experience? • Progress, far from consisting in change, depends on retentiveness. When experience is not retained…infancy is perpetual. Those who cannot remember the past are condemned to repeat it. This is the condition of children and barbarians in whom instinct has learned nothing from experience. • George Santayana (1905)

4. Colorado’s QSEN team’s approach • Several collaborative workshops were held for CON faculty and our clinical partners • What is QSEN • How does QSEN interface with COPA? • What safety and quality initiatives are occurring in the clinical agencies?

5. Integration of QSEN with COPA • A framework and process developed by Carrie Lengerg to promote intial and continuing competence by integrating: Competence for contemporary practice Outcomes to be achieved for practice Performance of essential competencies Assessment structured for competence

6. The COPA Model • Creates “end-result” competence outcomes focusing on eight practice based core competencies based on today’s nursing needs • Focuses on learner competence and continued development

7. Summary of COPA Process Create outcome statements that are: Clear, precise, realistic, practice based, measurable ↓ Use interactive learning strategies that are most effective in achieving competence ↓ Evaluate the student through Competency Performance Evaluations (CPEs)

8. Lots of overlap between COPA and QSEN • Both models: • Based in a value model that emphasizes competence to protect patient safety • Rely on collaborative work with clinical agencies to define the most current trends in nursing practice • Employ an integrative paradigm in defining what is “nursing practice”

9. Eight Core COPA practice competencies and QSEN KSAs COPA CompetencyQSEN KSA 1) Assessment and Intervention skills Patient Safety 2) Communication Skills Teamwork/Collab Informatics 3) Critical Thinking Skills EBP 4) Human Caring/Relationship skills Patient Cent. Care 5) Teaching Skills Patient Cent. Care 6) Management Skills Quality Improv. 7) Leadership Skills Teamwork/Collab. 8) Knowledge Integration Skills EBP

10. Dr. Christine Tanner’s Integrative Model of Clinical JudgmentTanner, C.A. (2007) Thinking Like a Nurse: a research based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211.

11. Importance of a Developmental Approach to KSAs • “The biggest difference between a novice and an expert is a sense of salience.” Patricia Benner BeginningIntermediateAdvanced Health Assessment OB Med/Surg II Fundamentals Peds Public Health Med/Surg IMental Health Senior Integ. Practicum

12. Specific Examples of CON’s curricular updates • Health Assessment • Substantive introduction to EBP • Fundamentals of Nursing • Safety: National Patient Safety Goals, 5 Million Lives Campaign, IOM To Err Is Human, Fall Program in VA hospitals from DOD, CHA Armband Initiative • EBP: IOM’s Quality Chasm • Patient Centered Care: Picker Institute Report, Patient Centered Care: What does it take? ,Harvard Hospitals’ Collaborative: When Things Go Wrong: Responding to Adverse Events, Transcultural Nursing Care • Quality Improvement: IOM’s Crossing the Quality Chasm and More on Quality; articles on 10/08 Medicare’s policy to withhold payment for hospital errors; Atul Gawande’s article on Dr. Pronovost’s work on QI in the ICU environment • Teamwork & Collaboration: SBAR, TeamSTEPPS, IHI’s work on Rapid Response Teams • Informatics: Graves and Corcoran, “The Study of Nursing Informatics”

13. What have we learned? • Our faculty suffer from the silo phenomenon; they are most comfortable being autonomous and independent of other courses/faculty

14. What else have we learned? • Our faculty have not historically thought much about the education-service chasm. QSEN facilitates a much more smooth transition from school into practice for our new graduates.

15. And what else have we learned? • In our BS curriculum there are developmental gaps that do not support students as they transition from our beginning level classes to our intermediate level classes and then into our advanced level classes. We need to purposefully bridge these transitions for our students.

16. How are we responding to these lessons? • QSEN Implementation Team (5 members) • Two members of the QSEN grant team, the Director of the Learning Laboratory, the Director of the Simulation Laboratory, and a clinical liaison employed by the CON and our largest clinical partner (UCH) • Explicit facilitation of the threading of the QSEN KSAs throughout our BS Program: • Here is what the classes before and after yours are covering in QSEN – how will you build upon these KSAs and prepare students for the next developmental stage? • How are the QSEN KSAs present in your Learning Laboratory activities? In your simulation activities? In your clinical roation activities? • What competence outcomes for your class overlap with the QSEN KSAs?

17. Development of common faculty/clinical partner QSEN resources • Development of QSEN modules on HealthStream for fculty and clinical partners

18. EBP and Evidence Based Educational models • We know that evaluation and collection of the right data are important: • Participation in QSEN survey to our May ’08 graduating seniors • After our “intervention group” graduates, we will survey them about their percpetion of the impact of QSEN content on their practice • We will also survey our clinical partners about any differences they see in our new grads whose curriculum had a strong QSEN foundation

19. Ongoing reflections… • The Chinese symbol for crisis is the symbol of danger over the symbol for opportunity • Danger: How do we broaden our BS faculty’s perspective enough so that QSEN is not “another thing to add to my course?” • Opportunity: Our first group of students are truly asking new questions

20. Strategic planning for the future is the most hopeful indication of our increasing social intelligence. William Hastie

21. One last thought…. It’s not because things are difficult that we dare not venture. It is because we dare not venture that they are difficult. Seneca (mid 1st century Roman philosopher)

22. Many thanks… • Any questions?