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Evidenced Based Research, Best Practices, and Success Strategies


Evidenced Based Research, Best Practices, and Success Strategies Mary J. Yoho, PhD., R.N., CNE Director of Faculty Development & Consultation Elsevier Health Science – PowerPoint PPT presentation

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Title: Evidenced Based Research, Best Practices, and Success Strategies

Evidenced Based Research, Best Practices, and
Success Strategies
  • Mary J. Yoho, PhD., R.N., CNE
  • Director of Faculty Development Consultation
  • Elsevier Health Science
  • m.yoho_at_elsevier.com

(No Transcript)
Evidence Based Education (EBE) Best Practices
Evidenced-Based Research Success Strategies
Evidenced-Based EducationWhats to Goal?
  • Select retain students most likely to succeed
  • Minimize attrition
  • Identify and remediate at-risk students
  • Prepare students for safe and effective nursing
  • Maximize NCLEX pass rates
  • Impact the nursing shortage
  • Other goals?

Evidence Based Education (EBE)Defined
  • An approach which argues that policy and practice
    should be capable of being justified in terms of
    sound evidence about their likely effects
  • Robert Coe, 1999 A manifesto for evidence-based

EBE Policy Practice
  • EBE signifies the idea that educational policy
    and practice should be guided by the best
    evidence about what works
  • Specific intervention strategies and policies
    should be rigorously evaluated before they are
    advocated or required
  • Where this is not possible they should be adopted
    experimentally, in such a way that their impact
    can be properly evaluated

EBE Culture
  • Evidence is valued over unfounded opinion
  • Appropriate evidence-based action is valued over
    action for actions sake
  • Reclaim debates about policy and practice for the
    professionals who know the most about the topic.

Current EBE Concerns
  • Opinion has the status of equal to or greater
    than that of evidence as a basis for action
  • Evidence is not value-free educational research
    carries its own values and objectives
  • Honest debate and discussion is often skewed by
    concealed evidence

Current EBE Hurdles
  • No quick-fixes
  • Time, funding, IRB, research, expertise
  • All strategies are not universal
  • Evidence can be complex, especially when
    interpreting statistical analyses

Greatest EBE Hurdle
  • The need to act often
  • precedes the evidence
  • Leading us to more
  • questions than answers!

Why should Nursing Education be Evidenced-Based?
  • The need evidence-based
  • Funding
  • Local, State, National
  • Institutional funds
  • Policy and practice change need justification
  • Can be difficult and time-consuming
  • Needs support by faculty and leadership

Most Compelling Outcome of EBE
  • The evidence to
  • support change must
  • be stronger than the
  • evidence or choice
  • not to change

How can Nursing Education be Evidenced-Based?
  • Implement an EBE culture
  • First question Where is the evidence?
  • Access the evidence
  • Set time for serious and informed debate
  • Be accountable.be able to justify and account
    for decisions based on sound evidence
  • Disseminate!

National Curriculum Revision Initiatives
  • State-wide
  • Admission Assessments
  • Reverting Clinical to Simulation and Virtual Lab
  • Consortiums
  • ADN to BSN initiatives
  • Proprietary-based Nursing programsa force in
    nursing education

Catalysts in Curriculum Evaluation
  • Accommodate more students
  • Who will accommodate the 41,000-92,000 qualified
    applicants to entry level nursing who were turned
    away? (NLN)
  • Compensate for the escalating demand for more
    nursing faculty
  • Increasing demand in service for nurse
    researchers, patient safety and quality, Magnet
  • Potential decrease with the closure of
    non-expansion of MSN programs and the additional
    of more DNP and PhD programs

More Catalysts
  • Remediate-to-Retain
  • Lecture/Clinical/Lab contact hours
  • Restructuring
  • Move clinical to simulation and eLearning
  • Add online courses
  • Accommodate additional content in the NCLEX-RN
    Test Plan

Coast-2-Coast Curriculum Initiatives
  • What are states doing?
  • Partnerships academic practice
  • Developing Consortiums
  • Program Entry Policies
  • State-wide curriculum standardization
  • Entry into practice

Coast-2-Coast Curriculum Initiatives
  • What is available to support curriculum
  • E-books
  • Curriculum online
  • I-pod downloads
  • Evaluation tools
  • VCE and simulation scenarios
  • Online case studies
  • Online skills
  • eLearning Initiatives are becoming more available

Partnerships Maryland
  • D D of Maryland SONs, Maryland Hospital
    Assoc., and Health Services Review Commission
  • Nurse Support Program II Increased the rate
    structure of all hospitals by 0.1, funds to be
    used for nursing education
  • Generates 8.8 mil annually
  • Funds used to support nursing programs,
    scholarships, stipends, fellowships for new
    nursing faculty (RWJF, 2007)

Partnerships Oregon
  • Providence Health System, OR Region University
    of Portland SON
  • Created Providence Scholars program scholarship
    funding for 75 juniors and 75 seniors, each year
    for 5 yrs16 mil
  • Students commit to work for Providence for 3
    years after graduation
  • Costs offset by savings of 100,000 per RN
    decreased orientation costs, turnover
  • Funds 12 masters students...hospital staff RNs
    to academia (RWJF, 2007)

Partnerships Loyola University Chicago SON
  • Partnering with clinical agencies
  • SON sponsored nurse executive breakfasts
  • Provided a forum for sharing education and
    practice issues
  • Networking and updating
  • Creation of a Nursing Partnering Community
  • Magnet application
  • Grant writing
  • Consultation
  • Share clinical agency staff and resources

Consortium Massachusetts
  • 11 competencies agreed upon by an education and
    practice consortium
  • Patient training
  • Do not ask a nurse what their degree isbut if
    they are competent
  • Competency is the priority!!

Consortium California
  • Foundation for CA Community Colleges
  • 2.3 mil in funds to track new nurse graduates
  • Closed Cookie Jar 2000 emergency funds to keep
    a student in school
  • Documentation Training for nurses to nurse the
    patient, not the computer.

Program Entry Policies CA (cont)
  • California Community College Chancellors Office
  • Initiatives for state-funded ADN programs
  • Moving from open enrollment-lottery system to
    selecting the most qualified students prepared
    for the rigors of the nursing curriculum

Program Entry Policies CA
  • 14 mil for admission initiatives8 mil for
    standardized admission testing
  • Elsevier A2 selected as one of 3 pre-admission
  • Had to demonstrate psychometrics and EBE
  • Cut score for the exam established by the CCCCO
  • Students not meeting the score must be remediate
    by the SON, and re-evaluated for admission.

A² Study 1 The Predictive Accuracy of the HESI
Exams for an ADN Program
  • Study Outcomes
  • A² reading comprehension sub-test scores were
    predictive of academic success and significantly
    related to MC scores (p .001) and to E2 scores
    (p .05)
  • The MC scores were predictive of nursing student
    success on the E²
  • (p .001).
  • The E² was highly predictive of student success
    on the NCLEX-RN with 94.82 Predictive Accuracy
    to the NCLEX-RN

A² Study 2 Evaluating success and curricular
outcomes using HESI exams in ADN and BSN programs
  • Examined both ADN (N 68) and BSN (N 69)
    nursing students who took the A² exam.
  • Study Outcomes
  • A statistically significant correlation with the
    A² scores and the beginning-level nursing course
    grades in the ADN and BSN programs (p .05) with
    final course grades in the Sophomore, Junior and
    Senior year.
  • High level of predictive accuracy of E² with
    NCLEX-RN success documented in both programs
  • ADN (96.43)
  • BSN (98.53)
  • A² validated as a significant predictor of
    success in nursing school and E² NCLEX-RN

Program Entry Policies Georgia Alabama
  • Georgia statewide entry exam for ADN programs
  • Alabama considering a statewide entry exam for
    ADN and PN programs
  • Already have a state-wide Biology exam
  • Flattens-out the applicants
  • Using EBE to support decision

State-wide Curriculum Standardization Oregon
  • Oregon Consortium for Nursing Education (OCNE), a
    partnership of Oregon nursing programs dedicated
    to educating future nurses.
  • Faculty from 8 community colleges and Oregon
    Health Science University School of Nursing
    have created a shared curriculum taught on all
    consortium campuses
  • Students can complete coursework for the BSN from
    OHSU without leaving their home community

State-wide Curriculum Standardization North

North Carolina ADN Curriculum Project North
Carolina ADN Curriculum Project 2 yr. grant from
the NC Community College System Plan Redesign
and restructure the ADN curricula to reflect one
curriculum standard to include major advances in
nursing and healthcare practices. Seamless
articulation for students 55 institutions. Include
s online hybrid nursing courses, PDAs iPods,
streaming videos.
State-wide Curriculum Standardization North
Carolina (cont)
  • State-wide Concept-based Curriculum
    Standardization North Carolina
  • Goal Increase nursing student retention among
  • Technology supports
  • eCourses
  • iPod downloads
  • Textbook on line
  • Online evaluation tools

State-wide Curriculum Standardization Hawaii
  • Hawaii Washington are considering state-wide
  • Initiated through either an education consortium
    (HI) or state nursing workforce initiative (WA)
  • How will they measure outcomes.besides NCLEX-RN?

National Curriculum
  • Proprietary nursing programs
  • Picking up forgotten nursing applicants
  • Starting with PNmoving to RN
  • Curriculum-in-a-boxremember Doc-in-a-box?
  • Smart, savvy, and business-minded
  • Use total curriculum solutions

Entry into practice
  • Should new graduates enter into practice before
    or after taking NCLEX-RN?
  • Reiter, Young, Adamson (2007) Decrease New
    Graduate Nurse Orientation Costs by Using HESI
    Exit Exam Scores JONA, 37(10), pp 459-463.
  • Goal to decrease cost of orientating new grads
    who then do not pass NCLEX-RN (costs
    39,000-65,000 per grad.
  • Hired New graduates with a HESI Exit Exam score
    of 870 or gt
  • The retention rate for new graduate nurses during
    this study was 98 after 1 year
  • Conclusion Validated the use of HESI E2 scores
    as a predictor of employment success by nurse
    managers and educators was validated by this

Beyond the US.Foreign Grads
  • NCLEX-RN pass rate for Internationally prepared
    RN grads 52.0
  • As compared to 52.4 pass rate for repeat US
    educated testers
  • 13 of all practicing RNs are from international

EB Research Foreign Grads
  • Parrone, et/al (2008). An evidenced based
    teaching/learning strategy for foreign nurses
    involving the HESI exam as a predictor for
    NCLEX-RN success. www.JTNL.org.
  • N67, 100 pass rates for students who achieved
    their cut score of 85 (850).

Beyond the USCanada
  • Canadian Nurse Association Exam
  • Multiple choice questions
  • Not psychometrically evaluated as NCLEX
  • Case studies
  • Puts test-taker in the clinical situation

Beyond the USInternational
  • Philippines and India
  • Prepare graduates for NCLEX-RN before the new
    graduates come to the US
  • Global nursing shortagecontroversy between
    bringing in foreign grads vs leaving qualified
    applicants behind
  • Nursing shortage is international too!

Identifying best practices
  • Partnerships
  • Consortiums
  • State-wide initiatives
  • Online
  • Simulation
  • How do we evaluate?

EBE does not need to be hair-raising
  • Closing Advise
  • Set the culture
  • Access the evidence
  • Use global research but think local
  • Use EBE at every opportunity
  • Be prepared to justify your decisions on evidence
  • Disseminate!

Best Practices for Student Success On-line
The Classroom Has Changed!
  • Then and Now

Rationale for Implementing Online Testing
  • Assess the preparedness of applicants
  • Evaluate and rank applicants according to faculty
  • Evaluate student knowledge and critical thinking
  • Statistically analyze exam results with
  • Internal and external curriculum evaluation
  • Prepare for annual and accreditation reviews

Advantages for Implementing Online Testing
  • Electronically bank test items
  • Download faculty-made items
  • Download text book items
  • Easily add alternate format items
  • Pilot test items
  • Accumulative statistics
  • Electronic exam blueprints

Advantages for Implementing Online Testing
  • Electronically bank test items
  • Download faculty-made items
  • Download text book items
  • Easily add alternate format items
  • Pilot test items
  • Accumulative statistics
  • Electronic exam blueprints

Testing Software.what should faculty use?
  • House and organize item and exam banks.
  • Selective faculty access
  • Item analysis
  • Cumulative item data
  • Report Test data

Online ExamsEvaluate Your Nursing Curriculum
  • Internal Curriculum Evaluation
  • Reliable Valid test items exams
  • Coordination with
  • the NCLEX-RN Test Plan
  • QSEN Competencies
  • NLNAC Competencies
  • AACN Competencies
  • Nursing Concepts

Testing Software.what should faculty use?
  • Faculty access and tracking of scores
  • Students can access and track their scores
  • Provide individual student remediation.
  • Track academic program performance

Creative Online ExamsUsing Textbook Items
Evidenced-Based Research Standardized Testing
HESI Evidence-Based Research Overview
  • State of our Science
  • Research In Press and Near Press
  • Research Advisory Board

Exit Exam Validity Studies
Predictive Accuracy HESI Exit Exam (E²)Validity
6 Results
Predictive Accuracy HESI Exit Exam (E²)
Validity 7 Results
  • Stratified Random Sample
  • 137 schools surveyed
  • 72 returned questionnaires (53)

E2 Version 1
Repeat E2 Version 2
Repeat E2 Version 3
Validity 7 StudyOnline Case Studies
  • Does the utilization of Evolve Case Studies
    significantly increase baccalaureate and
    associate degree registered nurse student scores
    on the Evolve exit examination as compared to
    students who do not use Evolve Case studies?
  • Random Stratified Sample
  • Two-way Analysis of Variance

Findings Case Studies
Means and Standard Deviations of E2 Scores by
Program and Case Study Utilization
Findings Case Studies
Two-way ANOVA Summary for Interaction and main
Effects for Case Study Use and Program Type
Research Understudy Does Online Remediation
Increase Student Exam Scores?
Research Understudy Does Faculty Tracking of
Online Remediation Increase Student Exam Scores?
Best Practices for Student Success Simulation
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Simulation and Med Administration
  • There was compelling evidence that collectively,
    students in clinical placement generate fewer
    medication errors if they have had prior
    exposure to a related, simulation-based

  • Challenges in Clinical Nursing Education
  • Curriculum integration
  • Lack of faculty support / staffing
  • Pressure to integrate / use
  • Student recruitment
  • Lack of clinical sites / competition
  • Complexity of patients in hospitals
  • Opportunity for new teaching/learning model

Will you lead the charge to implement EBE
throughout your curriculum?
Thank You!!
  • Mary J. Yoho, PhD, RN, CNE
  • m.yoho_at_elsevier.com
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