Monitoring of the Quality of the Capstone Course in Nursing. Gail D. Wegner and Ellen M. Moore

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1 Monitoring of the Quality of the Capstone Course in Nursing by Gail D. Wegner and Ellen M. Moore Process improvement and quality monitoring is occurring in a variety of professions and organizations such as business, healthcare and education. At Purdue University Calumet, there is a strategic commitment both from the institution and individual schools and departments to participate in measuring student success and quality of the educational programs. In this paper, we will briefly explore examples of improvement and monitoring processes applied to the NUR Capstone Course in Nursing for the online RN-BS student, an Academic Partnership collaborative. Background. The Capstone course is an evidence-based quality improvement (EBQI) course that synthesizes previous knowledge, skills, and attitudes from evidencebased practice, quality, safety, and patient-centered care initiatives. Students are engaged in the completion of an evidence-based practice (EBP) project proposal. Each student develops a proposal in collaboration with a clinical liaison at a selected health care agency. Most often, the liaison is selected based on their place of employment, and generally a question of inquiry has been identified based on high priority quality and safety challenges. A potential solution based on the best available evidence is developed. Each EBP proposal heightens the need for evidence-based care in response to local, state, and national health care priorities. Setting realistic expectations and outcomes for RN-BS students enrolled in a 5 week course offering was quite challenging for us. As course designers, we are also teaching the same course over the course of a semester (15 weeks) to traditional pre-

2 2 licensure students. As course coordinators of the Capstone Course, NUR 49800, we were able to provide both the RN-BS and pre-licensure students with the same course description, course objectives, course readings, course outline, course content, and assignment rubrics. Although we had to tweak the course assignments for the RN-BS online student, for the most part, we were able to stay consistent with the course objectives and student expectation-developing an EBP project and/or proposal. Institutional Monitoring of Quality. At Purdue University Calumet (PUC), the baccalaureate nursing Capstone course is designated as an experiential learning course. It gained its experiential learning status in the Fall of 2008 and was one of the first courses to gain approval by the University using the National Society of Experiential Education (NSEE, 1998) Standards of Good Practice. With the start of the fall 2008 semester, Purdue University Calumet became one of a few national colleges and universities to integrate formal, structured components of experiential learning as a graduation requirement for all students. Experiential learning is a prominent factor in the six-year University strategic plan. The strategic plan identifies five University goals: fostering engaged learning, preparing an educated local workforce and citizenry, improving student success, supporting faculty and staff excellence, and developing a vibrant campus community (PUC, 2008). The Capstone course was designed to adhere to the learning standards supported by the National Society for Experiential Education (NSEE, 2009). The course is monitored and evaluated every two years by a curriculum subcommittee of the university senate. The Eight Standards of Good Practice for All Experiential Learning Activities (NSEE, 1998) are used as the monitoring framework. These eight standards

3 3 can be summarized: 1. Intention: All parties must be clear from the outset why experience is the chosen approach to learning; 2. Preparedness and Planning: Participants must ensure that they enter the experience with sufficient foundation to support a successful experience; 3. Authenticity: The experience must have a real world context and/or be useful and meaningful in an applied setting or application; 4. Reflection: Reflection is the element that transforms simple experience to a learning experience; 5. Orientation and Training: The learner, the learning facilitator, and any involved organizational partner must receive important background information about the context and environment in which the experience will operate; 6. Monitoring and Continuous Improvement: Experiences are dynamic and changing and all parties involved in the experience are responsible for ensuring that the experience provides the riches learning possible; 7. Assessment and Evaluation: Outcomes and processes should be systematically documented with regard to initial intentions and quality outcomes; and 8. Acknowledgement: Recognition of learning and the impact of the experience require reflection and monitoring through reporting, documenting, and sharing accomplishments. Instructor-owned Monitoring of Quality. In a complex and global world experts in all fields are up against two main difficulties. Gawande (2008) stated that the first is the fallibility of the human memory and action when it comes to mundane, routine matters that are easily overlooked and the second involves the point that people can lull themselves into skipping steps even when they remember them. (p. 36). In addition to the University system of monitoring experiential learning courses for course delivery and student outcomes, internal monitoring components were established by the two

4 4 course coordinators. Our conceptualization of monitoring includes the ongoing process of a feedback loop. Faculty can make changes based on student performance and student feedback keeping in accordance with experiential learning principles. Monitoring is an integral component of the Capstone course as it is an expectation that students share their final EBP proposal with their clinical liaison at the end of the course for future implementation in the clinical setting. Three of these monitoring components include course evaluation, detailed assignment rubrics, and EBP project paper checklists. To monitor whether or not students are meeting the course objectives and that we, as educators, are using the best teaching pedagogy, we encourage students to complete a course evaluation. This course evaluation includes rating their accomplishment of course objectives, evaluating teaching methods, and evaluating course readings and assignments, Identifying course strengths and areas that may improve course delivery are critically examined by course faculty for future revision. The Course Evaluation is implemented using a Qualtrics designed survey. We felt that student feedback is very important and helpful to us as we have used that feedback to make changes in the course since the first offering Rubric for Grading Title Page and Introduction We felt that providing detailed assignment rubrics was the key to student success in achieving the desired learning outcomes. Basically, the students needed to know what our grading criteria and standards were for each assignment (Andrade, 2000). To address this, we created rubrics that identify performance standards that are categorized as excellent, satisfactory and unsatisfactory. The rubric also evaluates writing style, grammar and American Psychological Association (APA) formatting. An

5 5 example of the rubric for Module 1 Assignment: Introduction and Title Page is shown in Table 1. Table 1. Title and Introduction Points Excellent Satisfactory Unsatisfactory Very clearly discusses purpose, relevance and significance of project to clinical site and discipline. Gives pertinent background information. (4 points) Identifies the PICO(T) question. (2 points) Discusses outcomes objectives concisely. (2 points) Included use of template. Adherence to grammar, spelling, length: APA format: margins, levels of headings, running head, pagination, and citations (if citations applicable) (2 points) A good attempt is made to discuss purpose, relevance and significance of project to clinical site and discipline. Some relevant information on background for reader understanding is missing. (3 points) PICO(T) question not clear. (1 point) Discusses outcome objectives, but may be slightly unclear or lacking insight. (1 point) Included use of template Adherence to grammar, spelling, length: APA format: pagination, margins, levels of headings, running head, and citations (if citations applicable) 2-3 errors (1 point) Provides little or no information on purpose, relevance and significance of project to clinical site and discipline. Provides little or no background information. (0 point) PICO(T) question omitted. (0 point) Outcome objectives omitted (0 point) Omitted use of template. Adherence to grammar, spelling, length: APA format: pagination, margins, levels of headings, running head, and citations (if citations applicable) More than 3 errors (0 point)

6 6 Checklists provide an additional mechanism for internal monitoring. A checklist is a detailed number of concise and actionable items that can be used repeatedly to identify weaknesses or lapses in the evaluation of student assignments and ensures that all the assignment details are evaluated. Checklists or Do Lists are a protection against failing to do all of the necessary steps. They are a way to remind us of the minimum number of steps in an explicit fashion, and can encourage higher performance by both students and coaches. Checklists have long been used by Boeing pilots when an engine fails and a Surgical Safety Checklist has been adopted by the World Health Organization (WHO) in 2009 (Gawande, 2008). A Checklist for Checklists includes development of the Checklist, drafting the Checklist and validating for appropriate use (Gawande, 2008). An example of the checklist for coaches grading Module 1 EBP Project Proposal is shown in Table 2.

7 7 Table 2. Module One Assignment: Introduction and Title Page Checklist (10 points) Criteria Yes No Title and Introduction includes Purpose, Relevance/Significance/Potential Outcomes, Clinical Question (PICO); clearly written work with all components included Reviewed Syllabus, Readings, Rubrics, Resources, Examples, and FAQ s. Assignment submission reflects understanding of course readings/resources PICO (Problem, Intervention, Condition, Outcome) within scope of Baccalaureate nursing practice One or more components of PICO omitted PICO scoped and scaled for reasonable workload in 5 weeks; well written Introduction includes background information with reference citation (APA) Reference Page started Follows APA format Written in third person (please avoid first person I ) Appropriate use of EBP Project Template Assignment submitted on time W. Edwards Deming (2000) stated that everyone needs to get involved to improve the effectiveness and ensure the quality of an organization. The American Society for Quality has identified four components of quality in education. These include accountability, curriculum alignment, assessment, and student satisfaction (Brown and Marshall, 2008). Establishing tools to guide the grading process as well as

8 8 tools to evaluate learning outcomes are important for educators to use to monitor outcomes and to address the four components of quality in education. We have found that rubrics and checklists are extremely beneficial for monitoring, quality improvement and for enhancing the quality of online teaching. Both students and coaches achieve a higher level of performance.

9 9 References Andrade, H. (2000). Using rubrics to promote thinking and learning. Educational Leadership, 57, 5. Retrieved from leadership/feb00/vol57/num05/using-rubrics-to-promote-thinking-and- Learning.aspx Brown, J., and Marshall, B. (2008). An effective strategy for improvement of program outcomes in higher education setting. Nursing Education Perspectives (29)4. pp Deming, W.E. (2000). Out of Crisis. Cambridge, MA: MIT Press: Gawande, A. (2008). The checklist manifesto: How to get things right. New York: Henry Holt and Company. National Society for Experiential Education. (1998). The Eight Standards of Good Practice for All Experiential Learning Activities. Retrieved from National Society for Experiential Education (2012). About Us. Retrieved from Purdue University Calumet (2008). The Strategic Plan Purdue University Calumet. Retrieved from 0Reports/ /Approval_of_Calumet_Strategic_Plan_Sept_2008.pdf

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