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Submitter Information

Author: Amanda S. Eymard, DNS(c), RN
Title: Assistant Professor of Nursing
Institution: Nicholls State University
Email: amanda.eymard@nicholls.edu
Coauthors: Rebecca Lyons, PhD(c), RN, Angele Davis, MSN, RN

Competency Category(s)
Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Continuing Education, Pre-Licensure BSN

Learner Setting(s)
Clinical Setting
Strategy Type Learning Objectives
The Tools are the evaluation strategy.
Strategy Overview
Innovative teaching strategies combined with ensuring safe nursing practice is a challenge for faculty across baccalaureate programs. Despite integrating innovative teaching strategies in the classroom, educators continue to struggle with evaluating students' ability to provide safe, competent patient-centered care in the clinical setting. Gaps in evaluation of clinical practice, the BSN Essentials, and the baccalaureate program's newly revised conceptual model provided an impetus for rigorous revision of current clinical evaluation tools.

Members of the baccalaureate research and evaluation committee developed a set of Clinical Performance Evaluation Tools incorporating the knowledge, skills, and attitudes for each of the Quality and Safety Education in Nursing (QSEN) competencies. Eight course/level specific tools were developed demonstrating progression throughout the program. Remediation strategies for each course were addressed with a separate tool, the Clinical Performance Remediation (CPR) Tool. Walsh (2010) and University of Portland (2011) shared clinical evaluation information and contributed to the development of the tools. Input from faculty representing all levels within the program was also welcomed and considered. In addition to incorporating the QSEN competencies, the faculty felt strongly about including a professionalism section within the tools. This presentation describes the process and outcome for creating an evaluation tool that blended an effective combination of QSEN's core competencies, the BSN Essentials, and the baccalaureate program's conceptual model.

Spring of 2012, each clinical nursing course across all levels will pilot implementation of the individualized course/level specific evaluation tools. The pilot study will provide student and faculty feedback and serve to improve the evaluation tools prior to creating the finalized versions, which will be implemented in the fall of 2012. Results of the pilot study and all evaluation tools will be presented and shared during this presentation. Nursing programs can enhance evaluation of students' clinical performance by incorporating the newly developed clinical performance evaluation tools. The tools will then be made available on the QSEN web site for use by other nursing faculty interested in incorporating the QSEN competencies into their clinical evaluation process.
Submitted Materials
Clinical-evaluation-tool-guidelines-revised-117.doc
CPR-Tool-for-225.doc
Level-I-N225-Clinical-Eval-Tool.doc
CPR-Tool-for-420.doc
Level-III-N420-Clinical-Eval-Tool.doc
Additional Materials
The evaluation tools are progressive throughout the entire curriculum. Remediation tools were developed for each course corresponding with the evaluation tool. The remediation tool is named the Clinical Performance Remediation (CPR) Tool, and are included in the package above. I will be glad to send any additional information upon your request.
Evaluation Description
The Tools are the evaluation strategy.

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Clinical Performance Evaluation Tools Utilizing the QSEN Competencies

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Author: Amanda S. Eymard, DNS(c), RN Title: Assistant Professor of Nursing Institution: Nicholls State University Email: amanda.eymard@nicholls.edu Coauthors: Rebecca Lyons, PhD(c), RN, Angele Davis, MSN, RN Competency Category(s) Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s) Continuing Education, Pre-Licensure BSN Learner Setting(s) Clinical Setting Strategy Type Learning Objectives The Tools are the evaluation strategy.

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sirc - simulation innovation resource center

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Repository of Instruments - International Nursing Association for Clinical Simulation & Learning

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A separate category for debriefing was also added. There was a good faith effort to place instruments in the correct categories, although many instruments can be placed in multiple categories. Where possible, the purpose or names of the instruments are identified above the citation. Citations grouped together under a bolded heading belong to the same category.

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A clinically aligned pain assessment tool employs a multidimensional approach that focuses on improving pain based on function rather than a single pain number.

Since pain is a multidimensional, complex experience, a new clinical tool is being proposed to fill just such as need-one that addresses the desire to improve overall function if treatment is to be successful. 1,2

That's the bottom line of our opinion piece in Pain Management Nursing, ¹ said corresponding author, Cary Reid, MD, PhD, director of the Translational Research Institute on Pain in Later Life at Weill Cornell Medical Center in New York City.

"What we advocate for is a move away from asking people to rate their pain on a 0 to 10 scale," he told Practical Pain Management, " the focus must be on the impact of that pain on a person's function. If the patient has a pain score of 8, but he is getting through a work day and going out to dinner, I am less bothered by that because it is not having a significantly adverse impact on his function."

On the other hand, he said, there may be people who are greatly impaired and unable to go about their activities of daily living despite the report of a pain severity score of just 2 or 3.

Dr. Reid presents a review of the policies and position statement that have been implemented in the past few decades, such as looking at ''pain as the fifth vital sign" and discussing why these approaches have not led to consistently improved pain management.

Beyond a Number, Using Function to Assess Pain

Dr. Reid applauded another report that also appeared in the same issue of Pain Management Nursing, ² in which researchers from the University of Minnesota Medical Center in Minneapolis reported success with a multidimensional pain assessment approach that goes beyond simply asking a patient about pain intensity-the CAPA tool for "clinically aligned pain assessment".

The tool includes five questions centered on:

For instance, when asked about function, answers can range from cannot do anything due to pain to can do everything they need to do. The tool not only measures intensity but looks at the effect on function and on sleep, as well as how well treatment is working.

CAPA is meant to trigger a conversation-without putting numbers on everything.

While many pain specialists already may have begun to move beyond assessing pain in a one-dimensional manner, this information may be especially valuable for physicians who have not found an acceptable approach or may find this new tool useful in their practice, Dr. Reid said.

Moving Away from Pain as the Fifth Vital Sign

Pain specialists and primary care physicians alike likely well aware of how prevalent a challenge treating pain has become. In the US, about 20% of women and nearly 17% of men have pain most days or daily, ³ according to data from the 2010-2011 National Health Interview.

Well-meaning guidelines have failed to help clinicians assess pain with sufficient effectiveness, Dr. Reid said. As long ago as 1995, experts were urging physicians to look at pain as ''the fifth vital sign." Soon after, the Veterans Health Administration introduced a national strategy to improve pain treatment, including pain screening using the one-dimensional numeric rating scale (NRS). 4

"However, it is important to recognize that measuring pain in that way has not improved outcomes," Dr. Reid said, "Another initiative designed to improve pain outcomes was a method of embedding pain-focused questions in the patient satisfaction survey-another fail.

In 2010, the Affordable Care Act linked Medicare reimbursement for hospitals to patient satisfaction rating. In 2012, the Centers for Medicare and Medicaid Services followed suit and implemented a survey that asked patients about the care they received from their providers and how well their pain was managed. ⁵

As a result, Dr. Reid said, "the satisfaction surveys about pain became intertwined with financial incentives for hospitals," and that may have produced pressure on providers to prescribe opioids, although research is mixed on that. ¹

Fast forward to 2016, when the American Medical Association voted to stop treating pain as the fifth vital sign, citing the likelihood that the initiative, along with other factors, has contributed to the driving up the reliance on opioids to reduce pain in across all settings.

Evolving Pain Assessment Solutions

That best way to assure that pain is properly addressed is by involving an interprofessional team that approaches the assessment of pain using a multidimensional approach, said Dr. Reid. Among the tools he discussed in his report, one of the most promising is the CAPA (clinically-aligned pain assessment) tool. 1 Employing the CAPA tool requires a conversation between the patient and the healthcare provider, with an emphasis on how the pain is affecting daily functioning.

A team from the University of Minnesota Medical Center in Minneapolis reports on its experience with CAPA in a separate article, ² appearing in Pain Management Nursing.

"CAPA is really focused on [the patient's] function," said Debra Topham, PhD, JD, RN, director of regulatory and compliance at the medical center and a coauthor. "What's vital," she told Practical Pain Management, " is the social interaction between the person using the tool and the patient."

Given the Joint Commission requirements on pain assessment and management, which took effect on January 1, the tool will be a valuable addition for all health care providers to consider using with their patients, Dr. Topham predicted.

Originally, she said, ''the University of Utah initiated the CAPA tool through their anesthesia program," then university officials gave her team permission to use and modify it.

Topham's team rolled out the CAPA tool throughout the hospital, except for pediatrics. About 90% of the evaluations were completed by the end of the first quarter in 2014. ²

Dr. Topham used a case history to illustrate the value of using the CAPA tool: One woman who presented with chronic pain gave a rating of 10 out of 10 to describe her pain using the numerical scale. However, the patient continued to knit (one of her favorite pastimes). When the staff inquired about her ability to knit while she was in such pain, she explained that knitting was a kind of a meditation for her-a way to relieve the pain.

After CAPA was put into play at their center, Dr. Topham said, their Press Ganey score trended upward. When the staff of one medical-surgical unit within the medical center was surveyed, 80% of the 21 respondents said communication had improved after the CAPA tool was used in place of the numeric pain scale; 66% of clinicians indicated a preference for it over the NRS. ²

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Better Approach to Pain Assessment Places Emphasizes on Function

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A clinically aligned pain assessment tool employs a multidimensional approach that focuses on improving pain based on function rather than a single pain number. Since pain is a multidimensional, complex experience, a new clinical tool is being proposed to fill just such as need-one that addresses the desire to improve overall function if treatment is to be successful.

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iowa hartford center of geriatric nursing excellence the university of iowa.

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Keela Herr, PhD, RN, AGSF, FAAN Professor & Co-Director, Iowa Hartford Center of Geriatric Nursing Excellence The University of Iowa. - ppt download

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 Discuss current state of pain care for older adults  Key challenges and future directions

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2015: Pain Assessment, the Key to Treating Pain in the Inpatient Setting-Yi

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Pain Assessment, the Key to Treating Pain in the Inpatient Setting

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Keeping Their Attention Innovative Strategies for Nursing Education.pdf

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Using Problem-Based Learning in the Clinical Setting to Improve Nursing Students' Critical Thinking An Evidence Review.pdf

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Print Version
What Are CATs?

Classroom Assessment Techniques (CATs) are generally simple, non-graded, anonymous, in-class activities designed to give you and your students useful feedback on the teaching-learning process as it is happening.

Examples of CATs include the following.

The Background Knowledge Probe is a short, simple questionnaire given to students at the start of a course, or before the introduction of a new unit, lesson or topic. It is designed to uncover students' pre-conceptions.

The Minute Paper tests how students are gaining knowledge, or not. The instructor ends class by asking students to write a brief response to the following questions: "What was the most important thing you learned during this class?" and "What important question remains unanswered?"

The Muddiest Point is one of the simplest CATs to help assess where students are having difficulties. The technique consists of asking students to jot down a quick response to one question: "What was the muddiest point in [the lecture, discussion, homework assignment, film, etc.]?" The term "muddiest" means "most unclear" or "most confusing."

The What's the Principle? CAT is useful in courses requiring problem-solving. After students figure out what type of problem they are dealing with, they often must decide what principle(s) to apply in order to solve the problem. This CAT provides students with a few problems and asks them to state the principle that best applies to each problem.

Defining Features Matrix: Prepare a handout with a matrix of three columns and several rows. At the top of the first two columns, list two distinct concepts that have potentially confusing similarities (e.g. hurricanes vs. tornados, Picasso vs. Matisse). In the third column, list the important characteristics of both concepts in no particular order. Give your students the handout and have them use the matrix to identify which characteristics belong to each of the two concepts. Collect their responses, and you'll quickly find out which characteristics are giving your students the most trouble.

Why Should I Use CATs?

CATs can be used to improve the teaching and learning that occurs in a class. More frequent use of CATs can...

Provide just-in-time feedback about the teaching-learning process

Provide information about student learning with less work than traditional assignments (tests, papers, etc.)

Encourage the view that teaching is an ongoing process of inquiry, experimentation, and reflection

Help students become better monitors of their own learning

Help students feel less anonymous, even in large courses

Provide concrete evidence that the instructor cares about learning

How Should I Use CATs?

Results from CATs can guide teachers in fine-tuning their teaching strategies to better meet student needs. A good strategy for using CATs is the following.

1. Decide what you want to assess about your students' learning from a CAT.

2. Choose a CAT that provides this feedback, is consistent with your teaching style, and can be implemented easily in your class.

3. Explain the purpose of the activity to students, and then conduct it.

4. After class, review the results, determine what they tell you about your students' learning, and decide what changes to make, if any.

5. Let your students know what you learned from the CAT and how you will use this information.

Where Can I Find More CATs?

The standard references on CATs is Classroom Assessment Techniques: A Handbook for College Teachers, 2nd edition, by Thomas A. Angelo and K. Patricia Cross (Jossey-Bass, 1993). This book includes 50 CATs, indexed in a variety of useful ways. The book is available at the Center for Teaching library. See its ACORN record for call number and availability.

A number of web sites also feature information on and examples of CATs, including the following.

This teaching guide is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Print Version What Are CATs? Why Should I Use CATs? How Should I Use CATs? Where Can I Find More CATs? What Are CATs? Classroom Assessment Techniques (CATs) are generally simple, non-graded, anonymous, in-class activities designed to give you and your students useful feedback on the teaching-learning process as it is happening.

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Over the years I have been a part of countless online and live training initiatives that involved organic development. No matter what topic we were training to, the tool being used, the type of content (procedure, information, etc.), one thing remained the same across every single training implementation: learning objectives.

It can be easy to breeze over this part of the process, but in reality learning objectives are the most important part of the entire endeavor. Without proper objectives, you run the risk of incorrectly training your audience. What's more, you make it more difficult to measure the effectiveness of your training after implementation. As a general rule, it is important to ensure your objectives are measurable and are not broad sweeping statements.

You should also make sure to include objectives not only at the course level, but the lesson level as well. Constant reinforcement of these objectives is important not only to the learning, but also to any instructional designer who is building a course. Doing so will help guide the course progression in a way that is in-line with the objectives so that key points are effectively communicated.

There are countless of websites and articles that discuss the importance of learning objectives and best-practice when building them. As such, I found the following infographic (author unknown) to be a good place to start if you are new to the training development and delivery. One final note, writing objectives is an art that takes practice. Make sure you continually practice and refine your objectives over time. You will find that the process becomes easier with the more exposure you get in the field as you get a few successful learning implementations under your belt.

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3 Steps for Creating Effective Learning Objectives [INFOGRAPHIC] - LearnDash

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Over the years I have been a part of countless online and live training initiatives that involved organic development. No matter what topic we were training to, the tool being used, the type of content (procedure, information, etc.), one thing remained the same across every single training implementation: learning objectives.

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March 2017 Vol. 12 No. 3

Author: Wendy Tuzik Micek, PhD, RN, NEA-BC

After preparing and submitting documents to the Magnet Recognition Program®, you and your colleagues wait, hoping for a phone call to announce a site visit, the next step in the process of obtaining designation as a Magnet® organization. Finally, the anticipated phone call occurs, and the visit is scheduled. You and your colleagues experience a flood of emotions as you begin preparing for this high-energy event.

The Magnet Recognition Program identifies healthcare organizations that provide quality patient care and achieve excellence in professional nursing practice. Nursing staff must take specific steps for their facility to achieve this recognition. Early steps include submitting an application and preparing and submitting supporting documentation. In this article, I'll discuss, based on my experience, how to manage the next part of the process-a site visit by appraisers from the American Nurses Credentialing Center (ANCC), the organization that grants Magnet recognition.

Your site visit may be scheduled anywhere from 4 to 9 months after you submit your documentation. The timeline differs for every organization. Once site visit dates are confirmed, the ANCC Magnet office emails the chief nursing executive (CNE) and the designated Magnet Program Director (MPD) at your facility. This email marks the official start of the site visit phase of the Magnet recognition process, although I recommend that you begin preparing for the visit before you receive this email. (See Getting started: Resources to help prepare for a site visit

Staff members take on a variety of roles when getting ready for a site visit. When assigning roles, consider who can best meet the associated responsibilities rather than focusing on titles. (See Site visit roles and responsibilities.)

Preparing for a site visit is a major undertaking. To help make sure your site visit is successful-be flexible, stay focused, encourage staff to engage appraisers, and be prepared. And, yes, have fun.

The MPD coordinates the site visit and oversees all activities. If you take on this role, expect to:

* Work with the lead appraiser from the ANCC to set the site visit agenda.

* Send the lead appraiser your facility's unit staffing schedules for site visit dates. Scheduling information is used to select participants for the breakfast, lunch, and dinner interviews.

* Add to the agenda any interviews that, although not requested by the lead appraiser, may be helpful in obtaining Magnet recognition. Share your recommendations and reasons for wanting to add these interviews. For example, my team added an interview with a group of staff who had attended a Magnet conference to our site visit agenda.

* Notify people scheduled for interviews.

* Confirm the time as soon as possible for community members and other people scheduled for interviews who are not on staff. If someone scheduled for an interview is not available during the requested time, notify your lead appraiser.

* Update documentation. Consider how much time has passed since you submitted Magnet documents. You may need to update your site's patient satisfaction, quality indicators, nursing satisfaction, and nurse education and certification material.

As MPD, you must have a strong understanding of all aspects of a site visit. My advice: Don't try to do it all yourself. Plan to partner with others during each phase of the visit. Seek administrative support to help book meeting rooms, schedule interviews, organize meals for appraisers, schedule meals for interviewees make travel arrangements, and coordinate completion of the attendance roster for each interview.

Another important role is serving on the Magnet Tracer Team. This team is responsible for educating staff in preparation for the site visit. Our organization established five Tracer Teams consisting of five members each.

Members of the Tracer Team were instrumental in creating a series of newsletters focused on pre - paring staff for the site visit. Newsletter content was based on concepts from the Magnet® Model, including transformational leadership, structural empowerment, exemplary professional practice, and new knowledge, innovations, and improvements. We sent a newsletter each month to nursing units and other healthcare team members, starting about 6 months before the site visit.

In the course of a month, each Tracer Team visited six to 10 units and held rounds, asking staff questions related to the content of the most recent newsletter.

These rounds simulated interviews with Magnet appraisers. The next month, each Tracer Team rotated to different units.

Following each round, the team gave the MPD an evaluation of the strengths and weaknesses of the unit to help guide future activities. Once all newsletter topics were covered individually, Magnet Tracer Team members compiled all the questions and randomly selected review questions to allow for ongoing practice and to help staff build confidence.

We also created a newsletter titled Magnet Is for Everyone targeted toward nonnursing employees, such as guest services, environmental services, and building operations, as well as volunteers, and another newsletter to provide basic Magnet information for physicians.

Committees working on Magnet recognition collaborated to organize an engaging kickoff event for both clinical and nonclinical staff-the Fall Festival. Participants visited educational stations that featured games to reinforce concepts essential to Magnet recognition; for example, a spin-the-wheel station to reinforce concepts of transformational leadership, a duck pond game to teach about structural empowerment, a trivia game to reinforce exemplary professional practice, and Bozo buckets to reinforce new knowledge concepts.

As a further step to keep employees informed, we provided each unit with a customized binder that contained the following items:

* updated, unit-specific graphs of key indicators

* patient and nursing satisfaction graphs

* tips for conducting unit rounds

* the nursing strategic plan

* presentations on topics related to Magnet recognition

* questions from the Tracer Team

* Fall Festival questions

* a summary of projects included in the Magnet document submission.

Some units created a bulletin board to display materials.

The MPD conducted sessions to prepare each team scheduled for appraiser interviews about 8 weeks before the site visit. The MPD provided examples of materials interview teams could take to the interview, materials already sent to appraisers, and new material to be shared with the appraisers once on site.

Interview teams have 60 minutes to share their accomplishments with appraisers. Encourage them to be creative. For example, our nursing research council displayed research and evidence-based practice posters throughout the interview room during their session.

During the site visit, appraisers will seek to verify, amplify, and clarify the contents of your Magnet application. They will hold meetings in many different locations at your site. Magnet escorts are responsible for making sure the appraisers arrive at the right place at the right time. Escorts and appraisers spend a lot of time together, so fostering successful relationships between them is important.

You'll need to create an escort schedule that works for your organization. We implemented 4-hour shifts and matched escorts with appraisers according to clinical specialty.

Escorts have to know where, when, and to whom they need to hand off the appraiser under their charge. A team of clinical and nonclinical staff who provide consistent focus on Magnet recognition over the years, the Magnet Advisory Council met with the escort team for the site visit. At the meeting, escorts introduced themselves and reviewed expectations and schedules for the visit. During the visit, each escort used a worksheet to document the names of patients who interacted with appraisers, key questions asked by appraisers, files requested, and physician interactions.

Escorts need strong time-management skills. They should carry a cellphone, know key phone numbers, and be familiar with the patient population of the units they'll be visiting. Responsibilities include making sure appraisers have plenty of bottled water and pointing out where bathrooms are located. When meeting an appraiser for the first time, the escort should ask how he or she prefers to be notified about time limits.

We developed an onsite resource called an Appraiser Guidebook, which was customized for each appraiser. Guidebooks were placed in each appraiser's hotel room on arrival day. The book included copies of the site visit staff notice, the public notice, updated unit graphs, background information on each escort, attendance rosters by interview, unit descriptions, and any new information provided by interview teams.

During the site visit, designate one room in your facility as the appraisers' homeroom. This way, they have a place to store their belongings, as well as to debrief with the CNE, the MPD, or each other. They can also use this room for onsite document review. Appraisers often are conducting interviews and taking notes while everyone else is eating, so make sure you have grab-and-go food items available for them in this room and at the hotel.

Thank the appraiser team before they leave for the airport as the site visit ends. Debrief with staff and team leaders. Share appraiser comments, determine what worked well, and get feedback on how the experience could be improved for the next time. Be sure to thank everyone for his or her hard work and contributions.

Take satisfaction in the positive effects the site visit had on your organization and the professional growth it inspired. More than likely, you worked long hours to prepare for it. Now organize your office, refocus on other work responsibilities, spend time with your friends or family, or even take a vacation. And be patient. You may wait as long as 8 weeks before learning whether you received Magnet recognition. (See Three key points about preparing for a Magnet® site visit

Wendy Tuzik Micek is director, nursing science, and Magnet Program Director at Advocate Christ Medical Center and Advocate Children's Hospital in Oak Lawn, Illinois.

Selected references

American Nurses Credentialing Center (ANCC). 2014 Magnet® Application Manual, 2014 edition. Silver Spring, MD: American Nurses Association; 2013.

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How to plan a successful Magnet® site visit - American Nurse Today

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March 2017 Vol. 12 No. 3 Author: Wendy Tuzik Micek, PhD, RN, NEA-BC After preparing and submitting documents to the Magnet Recognition Program®, you and your colleagues wait, hoping for a phone call to announce a site visit, the next step in the process of obtaining designation as a Magnet® organization.

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January 2018 Vol. 13 No. 1

A workshop helps frontline nurses pursue research interests.

By Stephanie A. Walton, MSN, RN, NPD-BC; Kara Sankey, MSN, CNL, RN; and Nichelle Jensen, DNP, APNP

Encouraging all levels of nursing to participate in research is an important component of establishing an inclusive research culture. Here's how we built that culture at our organization.

How we began

Our health system, which crosses nine counties and two states, includes two community hospitals, two critical-access hospitals, and over 48 outpatient centers. The organization received its first Magnet® designation with a systemwide project to introduce research to all staff. For the next designation, we implemented a learning-by-doing model, which consists of strategic planning sessions with clinical staff to develop research topics within the organization. Three clinical leaders from the team meet with key executive leadership to align topics from brainstorming sessions to help attain goals on the nursing strategic plan. The clinical staff and executive leadership together identify which areas the organization will pursue as research.

How the program works

This program encourages frontline nursing staff to participate in research by providing dedicated working time, resources, and motivation to pursue areas of research that are meaningful to their daily practice. Using a workshop structure, research proposals are written with a mentor present to help keep research groups on a strict timeline. (See Research workshop agenda.) This format allows for time and resources for bedside staff to engage in research, and focusing on patient outcomes keeps them engaged and improves participation. After research is completed, plans are developed to help researchers disseminate their findings internally and externally. The program consists of new cohort brainstorming sessions every 12 to 18 months to support continued growth and ongoing research development within the organization.

Spike in research

The program has resulted in an exponential increase in research activity. We went from one research project that took just over 2 years to complete, to four projects completed in the last 1½ years at five locations. These outcomes have been sustained over 2 years, proving that creating a structure helps embed research in the culture.

The authors work at Mercyhealth™ in Janesville, Wisconsin. Stephanie A. Walton is a patient navigator, Kara Sankey is director of IP case management and social services, and Nichelle Jensen is a hospitalist nurse practitioner.

Selected reference

Wilkes L, Jackson D. Enabling research cultures in nursing: Insights from a multidisciplinary group of experienced researchers. Nurse Res. 2013;20(4):28-34.

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January 2018 Vol. 13 No. 1 By Stephanie A. Walton, MSN, RN, NPD-BC; Kara Sankey, MSN, CNL, RN; and Nichelle Jensen, DNP, APNP Encouraging all levels of nursing to participate in research is an important component of establishing an inclusive research culture. Here's how we built that culture at our organization.

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March 2017 Vol. 12 No. 3

Author: Stephanie A. Walton, MSN, RN, and Deb Sitter, MA, BSN, BSM, RN-BC

Our hospital systems' journey to obtain Magnet® recognition led to an excellent opportunity: the chance to revamp and improve our nursing orientation program as part of the effort to achieve excellence in nursing practice. Our system consists of three hospitals that historically held separate nursing orientations-we combined them into a single, standardized orientation program.

But we didn't just standardize our practices. We took the leap from using a passive learning lecturestyle approach to implementing active, innovative learning strategies-giving our nurses a better chance to succeed at patient care.

We were two nurse educators responsible for three hospitals. Together, we identified challenges to combining resources and standardizing the orientation program, then brainstormed ways to address these challenges.

To coordinate multiple schedules at three different locations, we created a master orientation schedule and designated one educator as the main contact for scheduling. We selected the main campus as the location for orientation since the simulation lab, guest speakers, and majority of newly hired nursing staff were based there.

As the project progressed, we addressed scheduling glitches and the need for more instructors. We also enhanced coordination between departments. For example, based on feedback from new hires, we combined a half-day class in patient handling taught by the physical therapy department with a half-day class in electronic health records taught by the informatics department into a 1-day session. This helped decrease costs associated with travel and time spent in orientation.

We discovered that hospitals in our system didn't always schedule time for nursing staff to attend orientation. We worked with human resources and nursing leadership to help make orientation for new hires standard practice across the health system.

Once we completed plans for combining all three hospitals' orientation programs, we reviewed the curriculum for the 2-day nursing orientation. We wanted to change the orientation format from lecture-death by PowerPoint-to a learner-centered approach.

We reviewed all three hospitals' orientation programs to determine what content was shared in common. Our goal was to develop one or more active-learning strategies for each topic category identified. Research shows that active learning strategies can increase retention of information and satisfaction with the learning experience and strengthen learner engagement. (See Topics and activities for first day of orientation

For example, in keeping the millennial generation's love of technology, we incorporated a tabletbased game into the review at the end of the first day's session. We made use of three tablets allocated for nursing education. An app guided a charadestyle game in which learners had to describe a topic covered during orientation without saying the actual name in their description. If the app displayed the words "bedside report," the nurse could say, "informing the next shift about the patient in the room." Nurses responded positively to this active approach to learning.

For the second day of orientation, we used simulation techniques to teach key patient safety topics. Simulation-based education engages the learner in hands-on activities, providing a safe but effective learning environment and creating fresh opportunities to improve communication and build knowledge and skills.

Course content was based on National Patient Safety Goals established by The Joint Commission to help healthcare organizations address issues related to patient safety. A manikin was used to simulate unsafe situations. (See Simulation activities to teach safety

Instructors present nurses with a patient care scenario using the manikin. Nurses must observe and identify what they find unsafe, as if participating in a scavenger hunt for clinical insights. In the discussion that follows, nurses gain insight into the relationship between their observations and safety goals.

The next activity reinforces expectations for customer service, defined in our health system's standards for critical moments of service. Each nurse selects a card inscribed with a critical moment of service standard. He or she then has to demonstrate delivering care according to that standard as part of a simulation experience using a high-fidelity manikin operated by the instructor.

The group then takes a break. During the break, instructors use the manikin to set up a patient fall scenario. When nurses return from break, they must simulate the appropriate response to the fall. The instructor then leads a discussion on proper fall investigation procedures and interventions to prevent future falls.

Next, nurses practice donning and doffing basic personal protective equipment, included in the curriculum as part of heightened awareness of highly contagious infections. The instructor asks the nurses to peer review a partner and correct any mistakes to reinforce proper procedures.

Other topics are I.V. therapy, during which nurses complete hands-on practice with an I.V. pump, and code blue procedures, including a basic review of the crash cart monitor and how to activate a code.

We implemented evaluation procedures to ensure that our new orientation program meets nurses' needs and effectively prepares them to deliver safer care. We send a survey to nurses soon after they attend. Feedback indicates that most find learnercentered orientation effective and engaging.

Nursing orientation at our health system is now more streamlined, more efficient, and, most important, relies more heavily on active learning. We continue to monitor for barriers to effective learning to ensure continued success of the orientation program and make sure the learning experience remains optimal. Ongoing innovation in orientation is needed to give nurses new to our organization the best chance to succeed in practice.

Stephanie A. Walton is education coordinator lead at Mercy Hospital and Trauma Center in Janesville, Wisconsin. Deb Sitter is medical/surgical and ICU supervisor at Mercy Walworth Hospital and Medical Center in Lake Geneva, Wisconsin.

Selected references

Aldridge MD. How can nurse educators perform patient simulation efficiently? Teaching and Learning in Nursing. 2016;11(1):8-14.

American Nurses Credentialing Center. Pathway benefits.

Billings DM, Halstead JA. Teaching in Nursing: A Guide for Faculty. 5th ed. St. Louis, MO: Saunders; 2015.

Jeffery AD, Jarvis RL. Staff Educator's Guide to Clinical Orientation: Onboarding Solutions for Nurses. Indianapolis: Sigma Theta Tau International; 2014.

Joint Commission, The. 2017 Hospital National Patient Safety Goals. The Joint Commission website. 2016.

Kennedy JM, Nichols AA, Halamek LP, et al. Nursing department orientation: Are we missing the mark? J Nurses Staff Dev. 2012;28(1):24-26.

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March 2017 Vol. 12 No. 3 Author: Stephanie A. Walton, MSN, RN, and Deb Sitter, MA, BSN, BSM, RN-BC Our hospital systems' journey to obtain Magnet® recognition led to an excellent opportunity: the chance to revamp and improve our nursing orientation program as part of the effort to achieve excellence in nursing practice.

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