Debra Hagler

The clinical nurse educator as leader

The National League for Nursing recognizes leadership as an important aspect of the educator role. The purpose of this article is to describe leadership in the context of clinical nursing education and how clinical nurse educators enact leadership. The article identifies particular nursing practice skills and strengths that clinicians bring to nursing education that enhance leadership knowledge, skills, and abilities. After review of several leadership models, we identified five overarching themes that demonstrate how clinical nurse educators exemplify the various models including role modeling, providing vision, helping students to learn, challenging the system or status quo, and seeking relational integrity. We explicate the themes with examples affirming the leadership potential of clinical nurse educators, and suggest ways in which nursing faculty members and administrators might draw on the leadership capital of clinical nurse educators.

Measuring competence: collaboration for safety.

Few options are available to nursing regulatory boards for the evaluation of nursing competency in registered nurses who are reported for practice breakdown. To address this deficiency, the authors conducted funded research through collaboration between their respective institutions: a state nursing regulatory board, a community college nursing program, and a state university nursing program. Through this collaboration, a competency evaluation process that used high-fidelity simulation was developed and was called the nursing performance profile (NPP). The NPP process consisted of evaluation of videotaped performances of registered nurses providing simulated patient care in three successive situations. Nurses who were experienced in both practice and supervision rated the performances according to scoring guidelines developed by the authors. Findings showed that the NPP process has the potential to (1) provide regulators, educators, and employers with a quantitative picture of nurse performance across nine areas essential to safe practice, and (2) establish a basis for recommending a specific remediation plan or continuing professional development.

Designing authentic assessment: strategies for nurse educators.

Increased emphasis on health care safety requires renewed attention to teaching and learning processes for future health care professionals. When presented with problems situated in a clinical context, learners have rich opportunities to demonstrate integration of concepts. Authentic assessment is an approach to evaluation of learning through which students can demonstrate acquired knowledge, skills, and attitudes in the context of real-world or realistic nursing practice activities. This article describes features, approaches, and examples of authentic assessment processes in the context of classroom, clinical, and online nursing education.

Designing Simulation Scenarios to Support Performance Assessment Validity

This article advances and demonstrates a validation process to guide the development of health care simulation scenarios for assessing performance competency. The development and evaluation of each scenario used in a simulation-based competency assessment must be based on multiple sources of evidence that support the validity of the assessment for its intended use. Procedures are proposed to optimize the validity of simulation-based assessments by linking the scenario directly to the instrument and using a systematic approach for gathering and processing input from experts in the field. This validation process is then applied to the development of an original scenario for use in an assessment of nursing competency that targets objectives through patient simulation scenarios scored by multiple raters.

Computer-Based or Human Patient Simulation-Based Case Analysis: Which Works Better for Teaching Diagnostic Reasoning Skills?

AIM The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation. BACKGROUND Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases. METHOD A total of 54 nursing students participated in two case analyses using human patient and computer‐based simulations. Participant performance and diagnostic reasoning skills were analyzed. RESULTS Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer‐based simulation. CONCLUSION Both human patient and computer‐based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.

Through the Lens of Instructional Design: Appraisal of the Jeffries/National League for Nursing Simulation Framework for Use in Acute Care

As human patient simulation becomes more prevalent in acute care settings, clinical experts are often asked to assist in developing scenarios. Although the Jeffries/National League for Nursing Simulation Framework has been used in academic settings to guide the instructional design of clinical simulations, its use in acute care settings is less known. This framework incorporates a consideration of contextual elements, design characteristics, and outcomes. An external validation study applying the framework within the context of acute care showed its overall strength as well as elements that were problematic. The implications derived from the study of the design characteristics in a hospital setting can be used by nurses who are considering either adopting or adapting this framework for their own practice.

Got PAD? Hidden dangers revealed with ABI

Peripheral artery disease (PAD), a result of atherosclerotic vascular changes to the endothelial lining of blood vessels, affects 8-12 million Americans and increases the risk of mortality as much as 50% from heart attacks and strokes. Early diagnosis and treatment of PAD along with early risk-reduction strategies have the potential to decrease societal health costs, as well as morbidity and mortality. PAD through screening with ankle brachial index (ABI), versus relying on existing physical exam and screening questionnaires, can increase the number of participants correctly diagnosed with PAD and lead to earlier treatment options. ABI screening was implemented in a primary care practice setting; outcomes were compared with historical rates and outcomes for participants at risk who declined ABI. Authors concluded that the participants who had ABI screenings that included arterial waveform analysis had a 78% rate of PAD diagnosis, whereas only 13% of the participants who did not elect ABI screening were diagnosed with PAD based on their symptoms and physical exam. Use of ABI screening led to increased frequency and awareness of PAD diagnosis and the opportunity for early intervention.

Integrating your experience and opportunities to prepare for nurse educator certification.

Certification is accepted as a universal affirmation of expertise. Nurse educators validate and demonstrate expertise in nursing education by earning the Certified Nurse Educator credential offered through the National League for Nursing’s Academic Nurse Educator Certification Program. Educators can prepare to achieve success in certification by reviewing eligibility requirements, creating an individual preparation plan, and using integrated, evidence-based learning strategies.

Testing Nursing Competence: Validity and Reliability of the Nursing Performance Profile

Background and Purpose: There is growing evidence that simulation testing is appropriate for assessing nursing competence. We compiled evidence on the validity and reliability of the Nursing Performance Profile (NPP) method for assessing competence. Methods: Participants (N = 67) each completed 3 high-fidelity simulation tests; raters (N = 31) scored the videotaped tests using a 41-item competency rating instrument. Results: The test identified areas of practice breakdown and distinguished among subgroups differing in age, education, and simulation experience. Supervisor assessments were positively correlated, r = .31. Self-assessments were uncorrelated, r = .07. Inter-rater agreement ranged from 93% to 100%. Test–retest reliability ranged from r = .57 to .69. Conclusions: The NPP can be used to assess competence and make decisions supporting public safety.

Using Generalizability Theory to Inform Optimal Design for a Nursing Performance Assessment

The promotion of competency of nurses and other health-care professionals is a goal shared by many stakeholders. In nursing, observation-based assessments are often better suited than paper-and-pencil tests for assessing many clinical abilities. Unfortunately, few instruments for simulation-based assessment of competency have been published that have undergone stringent reliability and validity evaluation. Reliability analyses typically involve some measure of rater agreement, but other sources of measurement error that affect reliability should also be considered. The purpose of this study is three-fold. First, using extant data collected from 18 nurses evaluated on 3 Scenarios by 3 Raters, we utilize generalizability (G) theory to examine the psychometric characteristics of the Nursing Performance Profile, a simulation-based instrument for assessing nursing competency. Results corroborated findings of previous studies of simulation-based assessments showing that obtaining desired score reliability requires substantially greater numbers of scenarios and/or raters. Second, we provide an illustrative exemplar of how G theory can be used to understand the relative magnitudes of sources of error variance—such as scenarios, raters, and items—and their interactions. Finally, we offer general recommendations for the design and psychometric study of simulation-based assessments in health-care contexts.