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Nursing Education in the U.S.: Academic, Orientation, Staff development,

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Title: No Slide Title Author: Ron Highfield Last modified by: Ron Highfield Created Date: 7/17/2001 4:07:55 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Nursing Education in the U.S.: Academic, Orientation, Staff development,


1
Nursing Education in the U.S. Academic,
Orientation, Staff development, Continuing
Education
  • Martha Highfield, PhD, RN, AOCN
  • Associate Professor Nursing
  • California State University, Northridge, USA

2
  • Presented at the invitation of the Guangzhou
    Municipal Health Bureau
  • Guangzhou, China
  • August 2001

3
Topics of Discussion
  • Basic nursing education in the U.S.
  • Clinical competence quality care
  • How additional nursing competence is gained
    through
  • Orientation
  • Staff development
  • Continuing education
  • Assessing monitoring the quality of nursing care

4
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5
U.S. Nursing Education Practice Guided by
  • Professional Standards American Nurses
    Association other professional nursing
    organizations
  • Law Nurse Practice Acts

6
Professional Standards Education Licensure
  • Knowledge base
  • Human experiences and responses to birth, health,
    illness, and death. Nurses focus on these
    phenomena within the context of individuals,
    families, groups, and communities
  • Diagnosis, Interventions, Outcomes
  • Scope of Practice
  • Basic Advanced

7
Professional Standards Basic Nursing Practice
  • Graduate of approved school of nursing
  • Qualified by national exam to be RN
  • Baccalaureate degree
  • Caregivers for patients, families, groups,
    communities
  • Interventions based on desired outcomes
  • Coordinators of care
  • Integrate patient service delivery
  • Prepare for tests/procedures
  • Monitor responses to interventions

8
Law Education Licensure
  • Establishes education licensure criteria
  • To protect public
  • To hold those with licenses accountable for
    practice

9
Law Education Licensure
  • Activities of state Board of Registered Nursing
  • Approves all basic advanced nursing education
    programs
  • Issues RN license based on passing national exam
  • Oversees those with RN license

10
Law Education Licensure
  • Beyond basic education, requires
  • Orientation staff development related to work
    setting
  • Continuing education related to professional
    advances

11
Law Program Director Qualifications
  • Masters degree or higher
  • One year's experience in administration
  • Two years' experience teaching nursing
  • One year providing direct patient care or
  • Equivalent experience and/or education

12
Law Faculty Qualifications
  • INSTRUCTOR Qualifications
  • Names to Board of Registered Nurses
  • Valid, active license
  • Masters degree or higher
  • One year providing direct patient care
  • One year's experience teaching courses related to
    nursing or a course which includes practice in
    teaching nursing.

13
Law Faculty Qualifications
  • ASSISTANT INSTRUCTOR Qualifications
  • Baccalaureate including courses in nursing, or in
    sciences relevant to nursing practice
  • One year's continuous, full-time experience in
    direct patient care practice as a registered
    nurse.
  • CLINICAL TEACHING ASSISTANT qualifications
  • One year's experience, within the previous five
    years, as a registered nurse providing direct
    patient care.

14
Law Faculty Clinical Competence
  • Nursing faculty members whose teaching
    responsibilities include subject matter directly
    related to the practice of nursing shall be
    clinically competent in the areas to which they
    are assigned.... Clinically competent means
    that a nursing program faculty member possesses
    and exercises the degree of learning, skill, care
    and experience ordinarily possessed and exercised
    by staff level registered nurses of the clinical
    unit to which the instructor is assigned

15
Law Faculty Responsibilities
  • Instruction
  • Evaluation of students
  • Planning
  • Implementing curriculum content.
  • Clinical supervision only of enrolled students

16
Law Curriculum
  • Minimum 58 semester units (about 2 years)
  • 36 of units (62 of total) in nursing courses
  • 1/2 (18 units) theory
  • 1/2 ( 18 units) clinical
  • Theory clinical taught at the same time for
    medical-surgical, maternal/child, mental health,
    psychiatric nursing, and geriatrics
  • 6 units communication
  • 16 units natural, behavioral, social sciences

17
Law Curriculum must include
  • Personal hygiene
  • Human sexuality
  • Client abuse
  • Cultural diversity
  • Nutrition (including therapeutic aspects)
  • Pharmacology
  • Legal, social and ethical aspects of nursing
  • Nursing leadership and management.

18
Law Curriculum must include
  • Integrated concepts
  • Nursing process
  • Basic nursing skills
  • Human development
  • Interdisciplinary skills
  • Communication
  • Natural sciences
  • Related behavioral and social sciences

19
Competence is KEY to Quality Practice
  • Competence knowledge skills to do job
  • Basic competence from nursing program
  • Job-related competence established during
    employment orientation
  • Maintained by monitoring performance ongoing
    education

20
Law Education After Licensure
  • Continuing education within profession
  • Orientation to workplace
  • Staff development within workplace

21
Law Continuing Education
  • Relevant to RN practice consumer needs
  • Content above that required for licensure.
  • Course must meet educational standards set by a
    State Board or Professional Association.
  • Required in many states

22
Examples of CE Content
  • Academic courses in nursing
  • Other examples
  • Physical sciences
  • Social science
  • Behavioral sciences
  • Professional educational meetings
  • Patient education skills
  • Nursing administration skills
  • NOT included basic knowledge like CPR

23
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24
Orientation Requirements
  • RN must be qualified by experience, education,
    licensure, and credentials for specific job
  • Oriented to job role
  • Assessed as competent

25
Orientation Requirements (cont.)
  • Cross-training
  • Transfer training

26
Orientation Competence
  • Establishing new competence beyond basic
    education through
  • Classes assessment of knowledge
  • Clinical orientation assessment of skills
  • Validating prior education (knowledge)
    experience (skills)

27
Orientation for Competence
  • Includes information about particular
  • Healthcare agency
  • Nursing department
  • Clinical specialty area
  • Job role
  • It is NOT a repeat of basic nursing education.

28
Experts Guide Orientation
  • Hospital/Healthcare agency
  • Department
  • Job-Specific
  • Classes
  • Preceptors

29
General Hospital Orientation
  • The Mission, Vision, Values, Goals of Agency
  • General Personnel Policies
  • Overview of Orientation Competency Assessment
  • Safety
  • Sexual Harassment
  • Equal Employment Opportunity (EEO) process
  • Customer Service
  • Patient Rights, Confidentiality, Ethics, etc.
  • Performance Improvement (QA)
  • Basic Infection Control for Non Clinical Staff,
    etc.

30
Nursing Orientation
  • Organization of Nursing
  • Safety Emergencies CPR, codes, fire, etc.
  • Communications documentation
  • Paper electronic
  • With other departments disciplines
  • Nursing specific role provider, educator,
    administrator, researcher

31
Job Specific Orientation
  • RN Direct care provider
  • Age specific characteristics needs
  • Medications
  • Equipment
  • Role in quality of care
  • Admission discharge
  • Ongoing assessment and documentation
  • Rounds Shift reports
  • Preceptor
  • Other duties check crash cart, returning
    obtaining equipment

32
Job Specific Orientation for Competence
  • RN Educator Role in supporting competence of
    staff
  • Collaboration
  • Curriculum expertise
  • Orientation responsibilities
  • Staff development responsibilities
  • CE responsibilities

33
Job Specific Orientation for Competence
  • RN Administrator Leadership role
  • Managing staff budget
  • Monitoring quality of care
  • Monitoring maintaining staff competence
  • Procedure policy development

34
Job Specific Orientation for Competence
  • RN Researcher Advance knowledge
  • Conduct research
  • Role in staff education
  • Collaboration with administration education
  • Evaluate programs

35
Orientation Outcome Assessing Competence
  • Competence statements
  • Specific, measurable, objective, behavioral
  • Equipment practice
  • Example RN will correctly hang monitor IV
    fluids
  • Competency checklists
  • Used to assess document competence
  • Example 1. Obtains correct equipment. 2. Uses
    aseptic technique. 3. Checks fluid against MD
    orders. 4. Explains procedure to patient, etc.

36
Education for Clinical Specialty Example of
Critical Care
  • Basic RN education outcomes
  • Communication skills
  • Therapeutic intervention skills
  • Critical thinking skills
  • Orientation content (3 parts) General Hospital,
    Nursing Department, Specific Job Role

37
Education for Clinical Specialty Example of
Critical Care Job Role
  • Basic critical care specialty knowledge
  • Validated through BKAT
  • OR Taught through critical care classes
    validated by examination
  • THEN
  • Basic critical care specialty skills are taught
    and/or validated through preceptorship using
    competence checklists

38
Competence Statements Checklists
  • Multiple checklists
  • One for each skill
  • Preceptor uses checklists
  • Giving time for development of each skill
  • Developing simple skills to complex skills
  • Lets look at example of developing a checklist

39
American Association of Critical Care Nurses
(AACCN) Standards of Care for Critical Care
Nursing
  • EXAMPLE
  • Standard of Care 1 Assessment
  • The nurse caring for acute and critically ill
    patients collects relevant patient health data

40
AACN Standard I Assessment (cont.)
  • Measurement Criteria
  • 1. Data collection involves the patient, family,
    and other healthcare providers as appropriate to
    develop a holistic picture of the patient's
    needs.
  • 2. The priority of data collection activities is
    driven by the patient's needs.
  • 3. Pertinent data are collected using appropriate
    assessment techniques and instruments.
  • 4. Data are documented in a retrievable form.
  • 5. Data collection process is systematic and
    ongoing.

41
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42
Example of Checklist Use
  • We have developed 2 competency checklists. One
    for removing femoral arterial/venous sheaths
    using manual compression and one for the
    Femostop. All ICU nurses are required to watch a
    video on the procedure, observe the skill being
    performed by a "competent RN", and then performs
    skill herself supervised by an instructor
    throughout the procedure. The learner must
    perform the skill according to the competency
    standard at least 3 times to perform the skill
    alone.

43
Education for Clinical Specialty Example of
Oncology Nursing
  • Scope of oncology nursing practice includes
    clinical practice, education, consultation,
    research, administration
  • Oncology nursing is directed toward care of
  • individuals,
  • families,
  • groups, communities
  • with potential or actual diagnoses of cancer

44
Oncology Nursing Society (ONS) Standards
  • Oncology Nursing Practice
  • Advanced Oncology Nursing Practice
  • Oncology Nursing Education

45
ONS Oncology Nursing Practice Standards
  • EXAMPLE
  • Standard 1 Assessment
  • The oncology nurse systematically and continually
    collects data regarding the health status of the
    client

46
ONS Oncology Nursing Practice Standards (cont.)
  • Measurement Criteria
  • 1. Collects pertinent objective subjective data
    in timely, ongoing, systematic, culturally
    competent manner
  • 2. Collects data from multiple sources, including
    patient , family, healthcare team, community
    using appropriate techniques

47
3-5. Collects, communicates to healthcare team,
documents data in the following eleven
high-incidence problem areas
  • Prevention early detection
  • Information
  • Coping
  • Comfort
  • Nutrition
  • Protective mechanisms
  • Mobility
  • Elimination
  • Sexuality
  • Ventilation
  • Circulation

48
Developing Competence Checklists
  • e.g., Prevention early detection
  • Assesses environmental risk factors
  • Documents environmental risk factors
  • Communicates environmental risk factors to
    healthcare team as needed
  • Assesses personal risk factors
  • Documents personal risk factors
  • Communicates personal risk factors to team prn
  • Assesses early detection practice, etc.
  • Assesses cultural social factors, etc.

49
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50
Future of Nursing Education 10 Trends
  • 1. Changing demographics and increasing diversity
  • 2. Technological explosion
  • 3. Globalization of the World's Economy Society

51
Future of Nursing Education (cont.)
  • 4. The Era of the Educated Consumer, Alternative
    Therapies and Genomics, and Palliative Care
  • 5. Shift to Population-based care and the
    increasing complexity of patient care
  • 6. Cost of health Care and Challenge of Managed
    Care

52
Future of Nursing Education (cont.)
  • 7. Impact of Health Policy Regulation
  • 8. Growing need for interdisciplinary education
    for collaborative practice
  • 9. Current nursing shortage/opportunities for
    lifelong learning and workforce development
  • 10. Significant advances in nursing sciences
    research
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