Funding Acknowledgement

Transcription

1 The Development and Implementation of Capstone Objective Structured Clinical Examinations to Enhance Cultural Competency in Graduating Advanced Practice Registered Nurse Students Melissa A. Saftner, PhD, CNM Melissa D. Avery, PhD, CNM, FAAN, FACNM Deborah Ringdahl, DNP, CNM Funding Acknowledgement Promoting Excellence in APRN Education: A Regional Approach to Quality, Safety and Diversity is funded by a 3-year grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) Grant # 1 D09HP Objectives 1. Discuss the Objective Structured Clinical Examination (OSCE) and purpose of the OSCE for assessing safe beginning level Advanced Practice Registered Nurses (APRNs). 2. Identify cultural competencies within OSCE cases and discuss the lessons learned and best practices. 3. Discuss the OSCE and relevance to nursing education. 1

2 OSCE Definition Objective Structured Clinical Examination (or Experience) Used in medical examination in U.S. 4 th year, started in 2004 Development as a component of APRN programs Why a Capstone OSCE? Standardized approach to assessing clinical competence of DNP graduates in 4 specialties o FNP (family nurse practitioner) o A-GNP (adult/gerontological NP) o WHNP (women s health NP) o Nurse-Midwifery Why Cultural Competence? Shifting health care landscape APRNs are expected to manage more complex social needs Difficult to objectively evaluate students on cultural competence and cultural knowledge 2

3 Stages of Development Year 1: Planning and development of blueprint for capstone OSCE for four APRN specialties Year 2: Beta-testing-implementation, evaluation and revisions Year 3: Second Beta-testing, evaluate, revisions, remediation plan and establish passing criteria. Year 4: Implementation of Capstone OSCE for 4 APRN specialties. Further revision as needed Development of Blueprint Competency review Midwifery (Core Competencies) NP specialties Degree components Interprofessional Cultural competence Specialty competency review SP review and training IERC review Group review of cases and checklists Process Development of cases and evaluation checklists Group competency review Specialty identification of common key conditions and cases 3

4 Composite of Instructional Materials Case Learner Expectations Instructions to SP Instruction to Learner Patient Chart Findings Cards Performance Checklist Post-Encounter Learner Activity Student Reflection Case Components Learning objectives Patient demographics Subjective data Objective data o Physical exam o Diagnostics Differentials and Assessment Management plan Counseling and education Communication Cultural Competency 1. Facilitate student interaction with patients from diverse cultural backgrounds 2. Discuss/process cultural competency issues in debriefing sessions 3. Conduct pre-post assessment of student cultural competency. 4

5 Original Menopause Case Anita Phillips is a 53 year old Native American woman who has come to the clinic with complaints of daily/nightly hot flashes for the past 6 months. She consulted with family 6 weeks ago and has been using an herbal tea from a Native American medicine man with some improvement. She doesn t want to use hormones but wonders if there are other options because she is getting very worn out. Revised Menopause Case Anita Phillips is a 53 year old Eastern Indian woman who has come to the clinic with complaints of daily/nightly hot flashes for the past 6 months. She consulted with family 6 weeks ago and has been using an herbal tea with some improvement. She doesn t want to use hormones but wonders if there are other options because she is getting very worn out. Student Focus Evaluate patient desire for traditional vs. western therapies Honor patient s request to avoid hormone therapy Identify other alternative therapies that may help with menopause symptoms Ensure respectful communication throughout 5

6 Normal Birth Case (Done as learning tool prior to official OSCEs) Sara Richards is a 29 year old G2P1 in labor. Partner is deployed overseas. The step-mom has brought her to the birth center, but she has to return home to stay with the son. Sara has been in labor for the past 3 hours, and slept about 5 hours before waking up with contractions. The contractions are now about every three minutes, intense and last seconds. She is 5 cm dilated. She desires a natural birth. Student Issues Support woman without partner present Provide care and encouragement Vaginitis Case Stella Jones, a 25 year old African-American female, who presents complaining recurrent vaginal discharge and itching for 9 months. The problem was treated as a yeast infection 6 months ago, but the symptoms returned. Stella has tried vaginal creams and a douche and is now concerned for an STI or cervical cancer. The treatment costs are starting to add up. Stella takes oral contraceptives for birth control and has had 2 new sexual partners in the past year and lifetime partners. She is anxious about being judged. 6

7 Student Focus Identify risks for vaginitis and complete problem focused history and physical Respect patient s autonomy and choices Provide individualized, patient-centered counseling related to safe sex OSCE Challenges Finding women who fit proposed scenario can be challenging Students find the scenarios challenging when there is a desire for complementary therapies as opposed to western medicine Student Evaluation SP rating Faculty rating Self evaluation Types of items Domains 7

8 Passing Determination and Remediation Three levels of passing Pass No pass Pass with reservations Each case must be satisfactory Follow-up if any individual case not satisfactory, or if any domains unsatisfactory Student reflection, clinical site evaluation, re-testing OSCEs and APRN Education Formative OSCEs allow for early identification of student problem areas Allows observation of student competence on history, physical exam, cultural competence, etc. Provides opportunity for: Student self reflection Faculty feedback Structured remediation Builds student confidence OSCEs and APRN Education Summative OSCEs ensure competence as a safe, beginning level nurse-midwife or nurse practitioner Provide opportunity for formal, structured remediation Identifies areas that the student should focus on for continued growth and improvement 8

9 Further Information If you would like further information or if you would like to view OSCEs in process, please contact: Melissa Avery, Melissa Saftner, Debbie Ringdahl, Additional Research Traynor, M., & Galanouli, D. (2015). Have OSCEs come of age in nursing education? British Journal of Nursing, 24(7), doi: /bjon Wunder, L. L., Glymph, D. C., Newman, J., Gonzalez, V., Gonzalez, J. E., & Groom, J. A. (2014). Objective Structured Clinical Examination as an educational initiative for summative simulation competency evaluation of first-year student registered nurse anesthetists' clinical skills. AANA Journal, 82(6), Hsu, L. L., Chang, W. H., Hsieh, S. I. (2015). The effects of scenario-based simulation course training on nurses' communication competence and selfefficacy: a randomized controlled trial. Journal of Professional Nursing, 31(1), doi: /j.profnurs Additional Research Rush, S., Ooms, A., Marks-Maran, D., & Firth, T. (2014). Students' perceptions of practice assessment in the skills laboratory: an evaluation study of OSCAs with immediate feedback. Nurse Education in Practice, 14(6), doi: /j.nepr Phelan, A., O Connell, R., Murphy, M., McLoughlin, G., & Long, O. (2014). A contextual clinical assessment for student midwives in Ireland. Nurse Education Today, 34(3), doi: /j.nedt Shillerstrom, J. E., Lutz, M. L., Ferguson, D. M., Nelson, E. L., & Parker, J. A. (2013). The Women's Health Objective Structured Clinical Exam: a multidisciplinary collaboration. Journal of Psychosomatic Obstetrics and Gynaecology, 34(4), doi: / X

10 QUESTIONS? 10