Degree of assimilation:  React by adapting- Try

Acculturation:  How to adapt with blending- Do

Assertion:  My way or highway- Forget It

Cognitive

Psychomotor

Affective

Cognitive Domain

6 Types

Knowledge:  Learn it

Comprehension:  Understand it

Application:  Do it

Analysis:  Pick it apart

Synthesis:  Put back together

Evaluation:  Evaluate it

Knowledge Level

Words

Foundation

Action verbs:

Devine, Repeat, Record, List, State

Strategies:

Lecture, Visuals, Video, Audio, Examples, Illustrations,  Analogies

How and Why

Action Verbs:

Translate, Restate, Discuss, Describe, Recognize, 

Explain, Express, Identify

Strategies:

Questions, Discussion, Review, Test, Assessment, 

Learner Presentations, Writing

How to use knowledge

Action verbs:

Interpret, Apply, Use, Demonstrate, Illustrate,Schedule, Operate, Shop, Sketch

Strategies:

Exercises, Practice, Demonstrations, Projects, Sketches, Simulations, Role play

Separation of concepts or information into parts

Action Verbs:

Distinguish, analyze, differentiate, compare, contrast, criticize, diagram, debate, relate

Strategies:

Debate, problems, exercises, case studies, critical incidents, discussion, questions

Put it together

Action Verbs:

Compose, plan, design, formulate, construct, create, organize, prepare, manage

Strategies:

Projects, porblems, case studies, creative exercies, develop plans, simulations

Let instructor know if they have learned enough to get by

Action verbs:

Judge, appraise, evaluate, rate, value, revise, select, assess, measure

Strategies:

Case studies, projects, exercises, critiques, simulations, appraisals

Psychomotor Domain

Types

Imitation:  Repeating an act that has been demonstrated or explained, includes tiral and error.

Manipulation:  Skill or sequence is practiced to habit, still unsure of self.

Precision:  Skill has been attained, proficient.

Articulation:  Higher level of presision, modify movement to meet a problem situation.

Naturalization:  Response is automatic.  May experiment.  Muscle memory.

Psychomotor Domain

Verbs and Strategies

Action verbs:  

Select, point to, show, adjust, assemble, do, draw, control demonstrate

Strategies:

Videos, demonstrations, discussion, practice sessions, skills lab

Affective Domain

Types

Receiving pnenomena:  Willingness to receive or to attend to particular phenomena or stimuli (Emotional awareness)

Responding to pnenomena:  Active participation to seek stimuli out and gain satisfaction from working with or engaging in it (Emotional involvement)

Valuing:  Commitment tot he underlying worth or value guiding the behavior (Emotional attachment)

Organization of values:  How the value relates to those already held or to new ones being considered (Emotional priority)

Internalizing values:  Internalization of values to the point that behavior is consistent for personal, social, and emotional adjustment (Emotional integration- commitment)

Affective Domain

Verbs and Strategies

Action Verbs:

Describe, recognize, comply, respond, demonstrate, initiate, justify, defend, influence

Strategies:

Case studies, role playing, videos, questons, reflective journals

See Me

Mom's Infection Story

Evaluation Types

Norm-referenced

Grade on a curve

Compare individual to group performance

Evaluation Types

Criterion-referenced

Just a grade (BLS)

Compare individual with predetermined criteria

Evaluation Types

Competency-Based

Compare individual performance to standars critical for safe performance

BDR- VF/T

1. Process evaluation: general happiness with the learning experience

2. Content evaluation: change in knowledge, affect, or skill on completion of a learning experience

3. Outcome evaluation: changes in practice on a clinical unit after a learning experience.

4. Impact evaluation – organizational results attributable in part to learning

5. Total program evaluation – congruence of program goals and accomplishments 

Kirkpatrick's Model of Evaluation

First Level

Reaction

Basic

Likert scale

AIDET

Pt Satisfaction

Was the learner satisfied?

Kirkpatrick's Model of Evaluation

Second Level

Learning

Content

Tests

Return demonstration

Essays

Did the learner learn?

Kirkpatrick's Model of Evaluation

Third Level

Behavior

Learning transfer

Observation

Chart audits

Did the learning stick?

Kirkpatrick's Model of Evaluation

Fourth Level

Results

Effect/Impact

Patient satisfaction

Complaince

Did the program make a difference?

System's Theory

Framework for scope and standars

Inputs--  Learner and NPD Specialist

Throughputs-- Competencies, orientation, inservices, CE, research

Outputs--  Learning, change, growth, results

1. Fatal- failure to do could result in injury or death.
2. Fundamental-  Essential to professional definition of job.
3. Frequent-  Must be done many times.
4. Fixed- Must be accomplished within a specific time period.
5. Facility-  Aspect of job as required by the organization.

Learner--  Who

Condition-- items can use

Action- pass

Criterion- with 100%

Must always align with the Strategic Plan of the organization

Product

Place

Price

Promotion

Participants

If outside agency is supporting, may not influence the program in any way.

May give grant.

Return On Investment

Calculation

Cost-benefit ratio=  Program benefits/Program costs

Net Program benefit- Progrm benefits-program costs

ROI= Net program benefits/program costs x 100

8 functions

Orientation

inservice

competency management

clinical affiliations

preceptor development

continuing education

research and scholarship

facilitation of role transition

Initiation

Planning

Execution

Control

Closeout

Like heart chart

clarifying roles and responsibilities

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Fishbone chart

Graphical technique for grouping people's ideas about the causes of a problem

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Used to schedule organize, and coordinate tasks within a project

Stands for:  Program evaluation review technique

Complex GANT chart 

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Graphical representation of duraton of tasks against progression of time

Helps to monitor progress

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Visualization that shows the relationships between events and tasks and how the events affect each other.

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Simply a through-time plot of data without control limits

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Communication- Negotiation

Adversaries

Communication- Negotiation

Opponents

Communication- Negotiation

Allies

High agreement, high trust

Communication- Negotiation

Bedfellows

Team-building

Group Dynamics

Stages

Forming

Storming

Norming

Performing

Adjourning

Not always in order

Culture of organization

Organizational Dynamics

Mission

Vision

Values

Goals

Purpose

Strengths

Weakness

Opportunities

Threats

Educator

Facilitator

Change agent

Consultant

Researcher

Leader

Mentor

Contracting

Engaging

Disengaging

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Competing

Avoiding

Accomodating

Compromising

Collaborating

Change Theory

Lewin

Most Noted

Unfreezing-  Look at what needs changing

Moving or change- How provide information and support to help change

Refreezing-  Get back to equillibrium

Change Theory

Rogers

Four Phases

Impart knowledge

Persuade

Decide based on data and pilot study

Implement change on a wide scale

Confirm adoption

Change Theory

Lippitt

Seven phases

Diagnose problem

Assess motivation and capacity to change.

Assess change agent's motivation and resources

Select progressive change objective

Choose appropriate role for change agent

Maintain change

Gradually terminate helping relationship

More on role of NPD or chang eagent

Based on Levine

Change Theory

Appreciative Inquiry

Discovery

Dream

Design

Destiny

Evidence-Based Practice

How to formulate clinical questions

PICO

Population

Intervention

Comparison

Outcomes

Evidence-Based Practice

Hierarchy of evidence:

Evaluation of:

Level 1- Systematic review or meta-analysis of relevant trials or EBG

Level 2- Evidence from at least one well0designed clinical trial

Level 3- Well-designed control trial w/o randomization

Level 4- Well-designed case study

Level 5- Systematic review of studies

Level 6- Evidence from one study

Level 7- Expert Opinion

Research

Process

Identify the problem

Research Design

Data Collection

Data Analysis

Interpret results

Descriptive

Experimental

Qualitative

Quantitative

Quantitative Data Analysis

Nominal Definition

Number Classify characteristics

Morse Scale

Quantitavie Data Analysis

Ordinal Definition

Rank ordered

Pain Scale

Quantitative Data Analysis

Interval Definition

Distance of attributes, not magnitude

Likert

Quantitative Data Analysis

Ratio Definition

Meaningful zero, rank order, distance of attributes and absolute magnitude

Height and Weight

Learning Theories

Behavior Learning Theory

All behavior is learned through incentives or punishments

Pavlauv Dog

Educator's Role:  Arrange the environment, including the rie forcement, to produce desired behavior change and eliminate undesirable behavior

Learning Theories

Cognitive 

Active process

reorganizing information into new insights or understanding

Recognizing the learninr's past experiences, perceptions, ways of processing information and social influences that affect any learning situation is the focus of the educator

Needs Assessment

Educator's Role:  consider available information about the learners when organizing and presenting the educational content

Learning Theory

Social 

Combines principles from behavioral cognitive theories to propose  that learning occurs in the context os social situations

Learning is a social process

Nurse Residency Program

Educator's Role:  Act as an exemplary role model and select socially healthy exeriences for learners to observe

Learning Theory

Psychodynamic 

emphasized emotion and the importance of both conscious and unconscious forces in guiding behavior

Emotion

Educator's Role:  Work with learners to make unconscious motivations conscious and support the development of ego strength

Learning Theory

Humanistic 

Each person is unituqe, autonomous, and wants to grow i a positive way

Do it your self

Educator Role:  Facilitate learning, not to serve as the source of all information

Learning Theory

Multiple Intelligences Theory

Combines Theory

bodily inesthetic, visual-spatial, verbal-lingquistic, logical0mathematical, musical-rhythmic, interpesonal, intrapersonal and naturalist

Educator role:  use knowledge of learners' profiles and/or the intelligences themselves to design meaningful learning experiences

Benner's Novice to Expert Model

Novice

Advanced Beginner

Competent

Proficient

Expert

Novice:  0-6 months- learner has limited background and experience so rules govern behavior

Advanced Beginner:  6 months- 2 years- The learner has some experience but still needs extensive guidance.

Competent:  2-3 years- learner has a sense of mastery and is able to eprform adequately on a day-to-day basis unless ajor variations occur

Proficient:  4-5 years- learner perceives global aspects of situations, recognizes variations, and knows how to modify poans appropriately

Expert:  5-7 years- learner intuitively grasps each sittuation and problem-solves creatively and effectively

Step 1:  formulate the buring question (hypothesis)

PICO Format

Population, intervention of interest, comparison intervention or status, and outcome

ex.  In new grad RN (population), does and RN residency (intervention) vs standard orientation (comparison) increase retention and recruitment (outcomes)?

Step 2:  Search for best evidence from a hierarchy of evidence

Step 3:  Conduct a critical review of evidence

Step 4:  Integrate the evidence with the provider's expertise, assessment of the patient, available, resourcesand the patient's preferences

Step 5:  Evaluate the effective ness of the Evidenced based intervention in meeting the desired outcome

Literature

Databases:  Cochrane/PubMed/CINAHL/QSEN/ERIC/PsycInfo/National guidlines Clearning house

Reliable resources

expert opinion

best practices

Preceptor roles and responsiblities

Reality shock theory

Adult education principles

Socialization principles

Eucation Process

Teaching strageties

Effective communication and feedback techniques

Problem solving and conflict management

Values and cultural impract on the preceptor-preceptee relationship

Documentation requirements

• One expected behavior
• an action verb
• audience (who)
• behavior (what)
• cndition (how)
• degree of attainment (how well)

• ARCS model of motivational design
• Attention, relevance, confidence, and satisfaction
• Sustain listeners' intereste (attention)
• Make presentation relevant and satisfying (relevance)
• Instill confidence; success encourages the learner to proceed (confidence)
• Leave satisfied after a learning goal has been achieved (satisfaction)

Types of Evaluation

Competency Based Evaluation

Criterion-referenced

Norm-referenced

Formative

Summative

Program

Competency based:  Assessment of a nurse's demonstrated ability to staisfactorily achieve specific behaviors essential to the role of the nurse and requirements of the job.

Criterion-reference:  Present criteria; BLS written; NT written

Norm-reference:  grade on curve; comparing the learner to others in a group

Formative:  Evaluation that takes place during the learning activity and is used to alter content or methods of teaching;  milestone meetings

Summative:  Evaluation that occurs after the activity; NT eval; certification

Program:  overall program; post oak orientation

Project- had an end

Programs have no end

Observer/fact-finder/expert

Change agent, facilitator

Educator/counselor

Confidant/sounding board

Couch/motivator/mentor

Gaining entry

Problem identitificaton

Action Plan

Evaluation

Disengagement

Remediation

Career development

clinical advancement

Quality improvement models

Focus/PDSA

• Find a process to improve
• Organize a team
• Clarify current knowledge of the process
• Understand sources of process variation
• Select the process improvement
• Plan
• Do
• Study or Check
•  Act

Quality improvement models

Process

• Plan a purpose, team, and project scope
• Research the current situation
• Organize data and do a gap analysis
• Create and try improvement
• Evaluate trial results
• Standardize the process
• Start Over

Quality improvement models

FADE

• Focus on a stratigic process to be improved
• Analyze data to understand the current process or identify root causes of variation
• Develop data-based action plans
• Execute action plans with ongoing monitoring

Research

Sampling Techniques

Simple Random-  table of random numbers to ensure that each unit in the population has an equal and indenpendent change of being selected

Stratified random-  divides the population into strata based on the saple criteria, then draws a predetermined number from each gruop using random sampling techniques

Cluster-  involves repeated rondom sampling progressing from large to small units over two or more stages (eg choosing a selection of samples from home health agencies, then selecting a sample of nurse case managers in home health agencies)

Nonprobability (convenience)-  reflects selction without the use of random selection

Convenience- a minimum number of suject or time frame is determines and everyone who meets the criteria is invited to participate

Quota-  divide the sample ito groups are identified, and then convenience sampline is used to fill the quota in each group.

Systematic- selection of every nth number of the avilable population, after beginning with a random start

Network sampling- an individual or group meeting the sample criteria id identifies, and the first and each subsequent member of the sample are asked to provde names of ther individuals meeting the sample criteria

Research Process

Data Analysis

Qualitative vs Quantitative

Qualitative- Verbal Narrative

Types:

Nominal- Mutually exclusive variables are organized into categories that canno be compared--gender or marital status

Ordinal- categories are ranked by the interval between rankings and are not necessarily equal such as levels of pain or educational levels

Interval- equal numberical distances exist between variables, such as a1-5 rating scale

Ratio-  highest measurement form expressing continuum of values with an absolute zero such as weight

• Transformational leadership
• structural empowerment
• exemplary professional practic
• new knowledge, iovation, and implementation
• empirical outcomes

Index of professional nursing governance (IPNG)

a respected measure of professional nursing governance of hospital based nurses

Measurement tool includes

• 88 item index
• six dimensions of shared governance
• Professional control
• organization influence
• organizational recognition
• facilitating atributes
• liaison
• alignment

Critical Thinking Framework as a part of

Domains of Learning

Skills

Analysis

Interpretation

Inerences

Explanation

Self-regulation

Concept mapping=  enables providers to see the relationship between what they are thinking and how it relates to the big picture

Graphically depicts a patient situation to identify correlation among diagnosis, data, phathophysiology, medical rders, procedure results, and collaborative interventions to achieve the patient's goals.