Building an Educational Model that Promotes Competence Through Innovation

Abstract

NURSING PRACTICE DEMANDS COMPETENCE, BUT NURSE EXECUTIVES REPORT THAT CURRENT NURSING EDUCATION DOES NOT PREPARE STUDENTS FOR THE REALITIES OF THE ACUTE CARE ENVIRONMENT. New graduates who lack understanding of the real world of nursing often leave the profession shortly after entry into practice (Institute of Medicine, 2011). Nurse educators must engage in revitalizing nursing curricula using innovative methodologies that also meet growing practice demands.Innovative methodologies and technologies that push the envelope of learning, particularly in the areas of cognitive knowledge acquisition and clinical reasoning, are currently employed on a wide but limited basis. For instance, online learning, once on the fringes of nursing education, is now an accepted teaching and learning modality. High-fidelity human patient simulation (HFS) has also taken student clinical learning to a new level of assumed competence. However, it is rare to find the two modalities paired together, particularly in pre-licensure nursing education.This article describes an innovative, multistate, online baccalaureate nursing education model used by Western Governors University College of Health Professions. The model combines online didactic methods with high-stakes, HFS assessment and a pioneering clinical coaching model. Graduates are competent scientists, detectives, and leaders in the healing environment.The CTUS Model Competence is key to nursing education and practice (Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009). This innovative, online approach to pre-licensure education is built on the newly developed CTUS model ( ognitive knowledge, ask skill knowledge, situated se of knowledge and ynthesis of knowledge and ethical comportment), developed by J. Jones- Schenk to ensure that all aspects of nursing competencies are mastered (Personal communication, November 9, 2010). Cognitive knowledge is attained through online course work, followed by mastery of task/skills and situated use of knowledge in simulation. Use of a coached clinical immersion model leads to synthesis of knowledge and the development of ethical comportment. Competence is assessed using a variety of appropriate methods. Competencies become increasingly complex as students progress through the curriculum.Program outcomes (competencies) were derived from a comprehensive set of national, state, professional, and institutional standards and the contributions of nationally recognized nurse professionals and leaders. Faculty then identified measurable course competencies and objectives and determined the type of assessment that would measure students' mastery. All students must demonstrate competence in all assessments to graduate.CONTENT KNOWLEDGE A variety of learning resources are used to deliver content in an asynchronous online format, including electronic textbooks, tutorials, and case studies. Content knowledge is assessed using standardized objective examinations, essay examinations, projects, or performance-based tasks. While students may participate in didactic content at their convenience, specified components must be completed in order to advance to the learning lab and clinical setting. Students must pass summative assessments for each course in order to progress to subsequent courses.TASK SKILL KNOWLEDGE/SITUATED USE OF KNOWLEDGE An underlying assumption of the model is that clinical education can be substantially transformed through the use of high-fidelity simulation. Clinical learning labs precede acute care clinical learning and build skills and confidence. The simulation curriculum is standardized across onsite clinical learning labs and includes scenarios designed to address high-risk, high-volume patient diagnoses across the lifespan. Scenarios reflect Health Cost and Utilization Project (H-CUP) hospitalization data (www.ahrq.gov/data/hcup/) and current quality and safety patient care initiatives.Since this online program does not have a physical campus, regularly scheduled simulation boot camps take place in simulation labs rented from schools of nursing and/or hospitals; the labs carry a full complement of high-fidelity simulators: adult, child, and mother-baby. …