West Hills College Lemoore Program Level Student Learning Outcomes Program Name/Title: Associate Degree Nursing Program Originator(s): Leslie Catron, RN, Marleen Smart, RN, Cynthia Dolata, RN Date: 4/16/2012, Final Revision 8/28/2012 Assessment for Class of 2010, 2011, 2012 I. Expected Program Level Student Learning Outcomes Defined SLO 1: Formulate a comprehensive plan of care using all components of the nursing process. With each semester s course, students are required to develop patient care plans, the core of the nursing process and patient care. This begins with a simple patient case in the first semester and finishes with comprehensive complex care plans for critically ill patients in the fourth semester. The objective threads throughout all nursing courses are: Describe the importance of developmentally sensitive, age appropriate nursing care. Utilize the nursing process and therapeutic communication to complete a comprehensive plan of care including assessment (for all age groups). Develop a plan of care for a client who has (course specific conditions), including teaching and discharge planning. Implement a plan of care that is developmentally appropriate and demonstrates cultural sensitivity. Develop and implement a plan of care for a client (all age groups). SLO 2: Safely perform basic psychomotor skills in the delivery of care as a technically competent clinician. Beginning with the first semester, students progressively learn and develop nursing skills in the on-campus skills lab and healthcare clinical setting under the instruction of a registered nurse (adjunct, faculty, and institution staff). The expectation is the delivery of these skills using safe, evidenced based technique to the level of pre-licensure competence. The objective threads throughout all nursing courses are: Discuss providing nursing care (activities of daily living) to all age groups. Discuss providing nursing care to all age groups. Perform an age-appropriate physical examination (for all age groups). Differentiate between common assessment abnormalities (terminologies) (for all age groups). Identify the essential data to be collected as part of an assessment (for all age groups).
SLO 3: Manage the clinical environment through assessment, planning, intervention, and evaluation. Starting in the first medical-surgical nursing course (first semester) and ending in the critical care nursing course, students must provide safe, competent (to their level of knowledge) patient care and manage the environment of care with team members. This happens in the healthcare clinical rotations under the supervision of a registered nurse (adjunct, faculty, and institution staff). The objective threads throughout all nursing courses are: Implement care for the client Assume responsibility and accountability for nursing activities in the role of the nurse. Provide competent care and comfort to the client considering developmental, biopsychosocial, cultural/spiritual needs in a safe environment. Provide safe and competent care to the antepartum, intrapartum and postpartum client SLO 4: Apply critical thinking skills to make judgments based on evidence (fact) rather than conjecture. Critical thinking skills develop progressively over the course of four semesters through theory and clinical course work being taught by qualified nursing instructors. This happens through Socratic questioning, interactive learning, and application of knowledge to practice. The objective threads throughout all nursing courses are: Scientific nursing knowledge: Describe anatomy and physiology of each body system. Discuss the pathophysiology of specific diseases and complications. Describe common signs and symptoms of altered functioning. Describe the etiology, pathophysiology, assessment, nursing diagnosis, and management of diseases, disorders, syndromes, and complications. Safe administration of medications: Define the basic responsibilities and accountability as a professional in terms of the legal aspects of medication administration. Discuss principles and safety measures of preparation of medications for administration Utilize the nursing process for medication administration. Discuss principles and safety measures of preparation of medications for administration. Implement age-appropriate techniques for the safe, accurate administration of medications, including intravenous therapy. Associate Degree Nursing Program Page 2 of 13
II. Mapping Program Level SLOs to Courses/Learning Experiences/Requirements Map the expected program level student learning outcomes (Section I) to all the courses, program requirements, and/or other learning experiences (i.e. work experience, internships, support services, etc.) that are a part of the program. Place an X in the box for each program level SLO that is introduced, emphasized, or reinforced in each of the listed courses or learning experiences. SLO 1 SLO 2 SLO 3 SLO 4 SLO 5 Course or Learning Experience Foundations of Nursing X X X Introduction to Medical Surgical Nursing 1 X X X X Beginning Medical Surgical Nursing II X X X X Intermediate Medical Surgical Nursing III X X X X Advanced Medical Surgical IV X X X X Obstetrics Maternity Nursing X X X X Psychiatric Nursing X X X Pediatric Nursing X X X X Gerontology Nursing X X X X Nursing Leadership, Delegation, and Management X X Pharmacology and Advanced Pharmacology X X X Associate Degree Nursing Program Page 3 of 13
Nursing Learning Labs: Beginning, Pharmacology and Obstetrical, Specialty, and Advanced Simulation Education: Clinical Simulation Day, Learning Lab, Open Lab, Student Simulation Assistant Program X X X X X X X X NC100 Open Lab Tutoring X X X X Associate Degree Nursing Program Page 4 of 13
III. Defining Assessment of Expected Student Learning Outcomes Identify appropriate assessment methodologies for the programmatic student learning outcomes, including summative assessments where appropriate. 1.) Formulate a comprehensive plan of care using all components of the nursing process. Method of Assessment Successful completion of patient care planning demonstrated by a score of 85% or better on written patient care plans in all courses. 2.) Safely perform basic psychomotor skills in the delivery of care as a technically competent clinician. Method of Assessment Demonstrate safe performance and management of patient care as seen by an 85% or better score in the clinical course work. Determine through provision of the activities of daily living, full patient assessment and intravenous skills. 3.) Manage the clinical environment through assessment, planning, intervention, and evaluation. Methods of Assessment Successful completion of patient care planning demonstrated by written patient care plans and a score of 85% or better in all nursing courses Acceptable Clinical Evaluation completed by the instructor with input from the institution registered nurse working with the student demonstrated by a score of 85% or better Associate Degree Nursing Program Page 5 of 13
4.) Apply critical thinking skills to make judgments based on evidence (fact) rather than conjecture. Methods of Assessment Demonstrate critical thinking and the ability to make sound, safe judgments for patient care. Determine through successful achievement of passing scores of 77% or better on all nursing course exams and medication mathematics exams. California Board of Registered Nursing NCLEX: 85% of all students graduating will pass the on the first attempt. Determined by using the California Board of Registered Nursing NCLEX Scoreboard and Summary Report Department of Consumer Affairs Board of Registered Nursing http://www.rn.ca.gov/schools/passrates.shtml Statistics are July 1 to June 30 National Council of State Boards of Nursing NCLEX-RN Pass Rate by Discipline https://www.ncsbn.org/1237.htm ATI Comprehensive Predictor Exam: All students who complete the nursing program will pass the 84% predicted probability for passing the NCLEX-RN Individual score >66.7% Assessment Technologies Institute, Inc.(ATI) RN Comprehensive Predictor Exam http://www.atitesting.com/ati_next_gen/reports/ Associate Degree Nursing Program Page 6 of 13
IV. Assessing Student Learning Outcomes Have the expected student learning outcomes for all courses or other experiences required in the program (sections II and III) been assessed? If all relevant courses and/or other experiences have been assessed, summarize the assessment data. Class of 2010 SLO 1: Four semester average - 92.6% SLO 2: Four Semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) ADL s 93/5% Assessment 97.4% IV Skills 100% (semester two only) SLO 3: Four semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) Care Plan Management of Care 92.6% Clinical Evaluation 96% SLO 4: Course Exams Average 87.7% Medication Exams Semester 1: 36% Semester 2: 86% Semester 3: 89.5% Semester 4: 89.8% Number of students passing NCLEX-RN first time 2009-2010 Taken through Jun 30: 2; Passed: 2; Pass Rate: 100% 2010-2011 Jul-Sept: Taken: 29; Passed:25; Pass Rate: 86.21% Oct-Dec: Taken: 2; Passed: 0; Pass Rate: 0% Combined score: 93.1% National: 87.41% (Jan-Dec) Number of students passed ATI greater than 85% predicted probability individual score >66.7%: 28/35 80% Group Mean National: 71.0% Group Mean This Program: 71.2% Associate Degree Nursing Program Page 7 of 13
IV. Assessing Student Learning Outcomes Have the expected student learning outcomes for all courses or other experiences required in the program (sections II and III) been assessed? If all relevant courses and/or other experiences have been assessed, summarize the assessment data. Class of 2011 SLO 1: Four Semester Average 94.89% SLO 2: Four Semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) ADL s 88.2% Assessment 93.9% IV Skills 95.8% (semester two only) SLO 3: Four semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) Care Plan Management of Care 94.89% Clinical Evaluation 98% (2 courses, third semester) SLO 4: Course Exams Average 89.47% Medication Exams - Semester 1: 56% Semester 2: 99.3% Semester 3: 100% Semester 4: 90% Number of students passing the NCLEX-RN first time: 2010-2011 Apr-June: Taken: 18; Passed: 18; Pass Rate: 100% Annual rate: Taken: 49; Passed: 43; Pass Rate: 87.76% 2011-2012 Jul-Sept: Taken: 15; Passed: 13; Pass Rate: 86.67% Oct-Dec: Taken: 3; Passed: 2; Pass Rate: 66.67% Combined Score: 85.3% National: 87.9% (Jan-Dec) Number of students passed ATI greater than 85% predicted probability individual score >66.7%: 29/35 82% Group Mean National: 68.7% Group Mean This Program: 68.3% Associate Degree Nursing Program Page 8 of 13
IV. Assessing Student Learning Outcomes Have the expected student learning outcomes for all courses or other experiences required in the program (sections II and III) been assessed? If all relevant courses and/or other experiences have been assessed, summarize the assessment data. Class of 2012 SLO 1: Four Semester Average 91.2% SLO 2: Four Semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) ADL s 95.75% Assessment 91.57% (2 courses only 1st & 2nd semester) IV Skills 100% (semester two only) SLO 3: Four semester average (beginning SLO data collection was not consistent course to course, some semesters have no data assessed) Care Plan Management of Care 91.2% Clinical Evaluation 98.95% (2 courses only, third semester) SLO 4: Course Exams Average 87.7% Medication Exams Semester 1: 85% Semester 2: 86% Semester 3: 100% Semester 4: 93.6% Students passed the NCLEX-RN first time 2012 Apr-June: Taken: 16; Passed: 16; Pass Rate: 100% Annual rate: Taken: 34; Passed: 31; Pass Rate: 91.18% State : no data available National: 92% (Jan-Jun) Number of students passed ATI greater than 85% predicted probability individual score >66.7%: 20/27 (ADN) 74% 5/7 71% (LVN-RN) = Total 25/34 73.5% Comparison data: LVN-RN Group Mean National: 69.7% LVN-RN Group Mean This Program: 70.2% Traditional Group Mean - National: 69.7% Traditional Group Mean This Program: 70.2% Associate Degree Nursing Program Page 9 of 13
V. Analyzing the Results of Assessment Have the assessment results for all courses and/or other experiences required in the program (sections II and III) been analyzed? If so, summarize those analyses. In other words, what does the relevant SLO assessment data tell you about student learning in this program. The final data demonstrates students progress and learning through the four semesters of this program. In that, beginning to advanced beginner competency is noted from the first to the last semester in all areas evaluated, establishing the student for entry into the healthcare field upon graduation. All data met and/or exceeded the expected outcomes for all three classes to date in all four student-learning outcomes. With the ongoing analysis, development and revision of the program, the data again indicates student learning remained consistent and even improved from one graduating class to the next. Example, medication mathematics not only showed improvement by semester as this material was continually reinforced but also year by year as the introduction to medication math principles were taught earlier and with more emphasis in the first semester course. All three classes met or exceeded the National pass rates for first-time test takers. Further, each class also met or exceeded the national mean on the ATI comprehensive predictor examination. The class of 2012 dropped below 80% on the percentage of students who passed the ATI predictor, a marked difference from the class of 2010 and 2011. However, this class (2012) had a considerably higher first-time pass rate on the NCLEX-RN of 91% nearly matching the national rate of 92%, which has risen from 87%. A probable reason for this success is that four students took an NCLEX-RN review and the NCLEX-RN exam the week after graduation. All passed. This trend continued through June and July. It must be noted: the ATI predictor exam does provide a correlating indicator of the percentage of students who will pass the NCLEX- RN the first time with the Class of 2012 exceeding the prediction and remains as an exit exam to the nursing program. More importantly, evaluating the overall program revealed inconsistencies in individual course evaluations. Not all courses focused on the same student learning outcome criteria. Each course does have specific objectives with coordinating student learning outcome evaluation for that objective, an important component to meet course expectations. However, all courses over the four semesters are linked to these four student-learning outcomes. Due to insufficient discussion from the inception of this new nursing program, data was not captured for clinical evaluations and psychomotor tasks (ADL s and assessments). Fortunately, at least one course from each semester provided insight into the students progression. ATI assessment exam data for each specific course was not evaluated in a consistent manner, either from a comparison with the national mean or with the percentage of those who passed at a Level II. Although all faculty review the results of these exams and make adjustments in their classroom teaching, deciding on a consistent outcome would be helpful for the program to evaluate course-by-course. Associate Degree Nursing Program Page 10 of 13
VI. Planning/implementing changes to pedagogy, facilities, etc. to improve learning Using the assessment results from sections IV and V, have changes to pedagogy, facilities, etc. been planned and implemented to improve learning in the program? Explain how the assessment results were used to plan and make changes to improve learning; and describe the changes implemented. If no changes are planned, explain why. Class of 2010 This was the inaugural graduating class for this new associate degree nursing program. All course material had just been newly developed by faculty and approved by the BRN. Simulation education was introduced to this class for the first time in the second semester and then again in the third semester during the pediatric theory with four simulation experiences. Two medical/surgical simulation experiences were provided in the fourth semester including an Advanced Life Support simulation before graduation. It was considered by faculty to be a successful year. The prepared curriculum needed only minor revisions to meet expected objectives in the class room and the clinical setting. This class had a high first-time NCLEX-RN pass rate, and retention, well above national, state and valley averages. Action: No changes were made to the curriculum or course content. Faculty agreed that expectations were met and it was still too early in the program to make significant changes. It was agreed that at the end of 2011, course content and skills would be evaluated for changes based on student outcomes. Medication Mathematics will have a stronger emphasis in the first semester foundations course with pre-course practice and preparation encouraged. The instructor will provide practice material to the students before and during the course. Tutorial and remediation will be available on a volunteer basis by the student with qualified instructors. The expectation is to see higher scores earlier in the program. Simulation will be developed and integrated into all courses. Although not captured here, satisfaction with simulation education was high and requested. The simulation coordinator added three important developmental concepts: 1. Each simulation will focus on the Quality and Safety Education in Nursing (QSEN) six core competencies for the pre-licensure student 2. Each simulation scenario will have evidenced based practice incorporated as indicated by peer-reviewed journal references (within the past five years), and each will be reviewed by content experts in that field (medical-surgical, obstetrical, psychiatric, pediatric and leadership nursing). 3. The simulation lab will be separated from the skills lab into a classroom space (711). This will provide improved availability for high fidelity simulation away from the practice of skills. This should be accomplished by December 2010 for use in the spring of 2011. Associate Degree Nursing Program Page 11 of 13
VI. Planning/implementing changes to pedagogy, facilities, etc. to improve learning Using the assessment results from sections IV and V, have changes to pedagogy, facilities, etc. been planned and implemented to improve learning in the program? Explain how the assessment results were used to plan and make changes to improve learning; and describe the changes implemented. If no changes are planned, explain why. Class of 2011 This class also met or exceeded goals and expectations. Simulation experiences started in first semester and included a student orientation to the simulation experience. By the end of graduation, these students experienced 12 simulated patient encounters tying theory and clinical knowledge to practice. The first-time NCLEX-RN pass rate was lower and that was due to the fact many students waited past three months post-graduation to take the test. This demonstrated the importance of resency when taking an adaptive computerized exam where competency is measured. Further, these students elected not to take the N101 course third and fourth semesters. These support courses demonstrated in the previous class of 2010 a stronger adaption to nursing concepts. Action: Subsequent classes will have early exposure in the third and fourth semesters to registering for an NCLEX-RN test date for June and July. Faculty will assist with this process ensuring more students take the exam early post-graduation. In addition, representatives from ATI, Kaplan, and Hurst will provide information regarding NCLEX-RN review. The elective N101 course curriculum will be changed and developed into the program curriculum, approved by the WHCL curriculum committee and the California Board of Nursing. The course is to be renamed and made mandatory for completion within the nursing program. New course titles: NURS 14A-Introduction to Nursing Learning Lab, 14B-Pharmacology /Obstetrical Nursing Learning Lab, 14C-Specialty Nursing Learning Lab, 14D-Advanced Nursing Learning Lab. These four courses (one each semester) are two units and incorporate theory concepts and interactive learning. This will provide a faculty to focus on the aspects that will increase cognitive and psychomotor learning through case studies, article review, workbook chapter review, and simulation experiences. These have been made part of the permanent program curriculum as of fall 2011 for the graduating class of 2012. College counseling will ensure that all students have an education plan their first semester and they are completing the required courses for graduation with an Associate Degree. This will enable students take required courses earlier in the program ensuring completion before graduation. NC100 will be implemented with the arrival of new full-time faculty. This open lab experience will be on Tuesdays and Thursdays from 3:00 to 4:00 p.m. During this time, students will have tutoring in medical math and writing an effective care plans along with skills and communication practice. Simulation will be fully integrated for the graduating class of 2012, with 21 simulation encounters. Simulation development will continue with content expert review, evidenced based practice and QSEN competency focus. The fall of 2011 will offer the first 12-hour clinical simulation day with students rotating out of the hospital. As part of the 5-Year Curriculum Review Process, faculty will ensure that psychomotor skills are taught at the same time as the theory component ensuring student learning. Highlighting the QSEN competencies within the nursing curriculum will be the next steps in aligning all curriculum. These six competencies will be assessed in the next program review. Associate Degree Nursing Program Page 12 of 13
VI. Planning/implementing changes to pedagogy, facilities, etc. to improve learning Using the assessment results from sections IV and V, have changes to pedagogy, facilities, etc. been planned and implemented to improve learning in the program? Explain how the assessment results were used to plan and make changes to improve learning; and describe the changes implemented. If no changes are planned, explain why. Class of 2012 An important outcome for this graduating class is the increase in the first semester medication math scores. The focus by the first semester instructor on pre-class and in-class work proved successful. Graduation, retention and first-time NCLEX-RN exam scores remained consistent with this class and met or exceeded the program goals. The decreased graduation rate was a result of the early counseling with students who still needed to meet general education requirements for Associate Degree. Students opted to extend their graduation date, taking these courses after completion of the RN program. This gave them opportunity to focus on nursing concepts. This was evident in the higher pass rate than previous classes. Further, it can be concluded that the addition of the NURS 14 classes and full integration of simulation education contributed to the higher first-time pass rate. Action: Counseling will continue early in the first semester and include a clear education plan with the Associate Degree as a goal for May graduation. Counselors will meet with students during the NURS 14A class and continue to meet with students on an as needed basis. New full-time faculty will take the first semester NURS14A class in the fall of 2012 and one full-time faculty will with NURS 14B, 14C, and 14D providing consistency in teaching and ensuring correlation with theory content. The NC 100 class was implemented in the fall of 2012 with new full-time faculty who give clear direction and course work focus for the students who elect or are required to attend related to their academic standing. The NURS 14B,C,D courses will have increased focus on evidenced based practice article review. Mini-simulation experiences (15 minutes patient cases) will be added in these courses to increase cognitive and psychomotor skills. These courses will also implement leadership, delegation, and prioritization content coordinating with the medical-surgical course module on leadership. The intent is to guide the student into nursing leadership responsibility and accountability earlier in the program thus providing opportunity to recognize nursing leadership and practice in the clinical setting. Finalize the 5-Year Curriculum Review ensuring the alignment of curriculum for student success. Associate Degree Nursing Program Page 13 of 13