post-graduate nurse practitioner fellowships: curriculum development & design

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Post-Graduate Nurse Practitioner Fellowships: Curriculum Development and Design

Marci Farquhar-Snow RN MN CCRN CMC ACNP-BC AACC Assistant Professor, College of Medicine Program Director, Cardiology Nurse Practitioner Fellowship (CNPF) Mayo School of Health Sciences [email protected]


I do not have any current commercial, non-commercial, or expert witness testimony relationships.

Disclosures


Objectives

•  Identify learning goals and needs for a nurse practitioner fellowship

• Design curriculum based on adult learning principles


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CNPF Overview

•  Established 2009

•  12-month program post-graduate

•  Two full-time fellows/year

•  300 didactic hours; 100 CME

•  1700 clinical/mentored hours

•  Funded by Mayo Clinic School of Health Sciences

•  First cardiovascular specialty PTAP accredited by ANCC


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Goals of Curriculum Development


Organizational Enculturation (OE) Learning Method #1: Independent risks

Learning Method #2: Mentored Practice

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Learning Goals and Curriculum Plan (DD)

•  Review standards and guidelines •  National •  Subspecialty •  State

•  Competency assessment •  entry-level knowledge and skills •  job requirements •  performance measures


Cardiology Nurse Practitioner Fellowship (CNPF) Learning Needs Self-Assessment

Method of assessment: The CNPF Learning Needs Self-Assessment form will be completed by the CNPF and key stakeholders at the onset of the program to identify areas of learning needs within the nurse practitioner scope of practice in various cardiovascular subspecialty areas. Directions: Please evaluate each of the following topics, using the scale below, to describe your experience with the topic as a NP either as a student or in current practice and your current confidence level to practice as a Cardiology Nurse Practitioner related to the topic. Thank you, Marci Please return to: [email protected] or MSHS 134000 E. Shea Blvd. Scottsdale, AZ 85259 ATTN: Marci Farquhar-Snow ACNP

Demographics of Participant:

Subspecialty area Highest degree obtained Years in practice as RN (skip if not a RN) Years in practice as NP (skip if not a RN)

Self-Assessment Scales:

Past clinical experience with the topic in a NP role Confidence Level as a NP to Manage

1=Low volume 1=Needs high level of assistance in management

2=Moderate volume 2=Need moderate assistance in management

3=High volume 3=Needs little assistance in management

Clinical Management Topic Experience Confidence Clinical Management Topic! Experience! Confidence!

General Cardiology Antiplatelet, oral medications Cardiac exam and assessment Cardiac trauma Coronary artery disease Cerebrovascular ischemic disease Diabetes, cardiovascular effects Thyroid cardiovascular effects Endocarditis Hematological disorders Hyperlipidemia Hypertension Palliative Care Pericarditis, constrictive vs. restrictive Preoperative Evaluation for Cardiac Risk Prosthetic heart valves Renovascular disease UA/NSTEMI/STEMI Valvular heart disease Preventative Cardiovascular Care Cardiac Rehabilitation Counseling, Exercise performance Counseling, Nicotine Cessation Counseling, primary and secondary prevention Counseling, Obesity management Reproductive Disorders, Cardiovascular risk Non-Invasive Cardiovascular Diagnostics CT/MRI Interpretation CXR analysis Cardiac ultrasound performance

Needs Assessment (PL)

•  Stakeholders

•  Clinical Practice Guidelines

•  Standards and Scope of Practice


Needs Assessment Exercise

Key Topics (Clinical/Professional) Strengths/Experience

Clinical

1.

2.

Professional 1. 2.


Development and Design (DD) Framework Self-Determination Theory (SDT)

Ryan and Deci (2000): Bandura (1977)

Basic psychological needs of adult learner

Relatedness • Sense of

belonging

Competence • Self-efficacy or

confidence

Autonomy • Choices and

consequences


Mentor Development (DD)

•  Role modeling •  professional activities •  role integration

•  Adapts to learner needs

•  Timely feedback

•  Ongoing guidance

•  Competency validation

Hayes (1998); Grossman 2013


Mentors Exercise

• Who are the mentors?

Profession Development Methods


Practice Based Learning (PBL) Application of Experiential Learning Model

Kolb (1984); Witt, Colbert and Kelly (2013)

Mentee Learning Needs

Concrete Experience Feeling • Challenging clinical practice • Didactic curriculum • Return demonstrations

Reflective Observation Watching •  Interprofessional (IPE)

collaboration • Evaluation and feedback

Abstract Conceptualization Thinking • Case Studies • Presentations • Collaborative research projects • Publications

Active Experimentation Doing • Simulated Learning • Hands-on anatomy labs • Procedure Skills labs


Professional Development Plan (PBL) •  Initial Assessment

•  pre-assessment evaluation •  standardized scenarios •  self-needs assessment

•  Formulate Plan •  priorities and goals •  review expectations •  assess learning styles

•  Evaluation •  monitor transition •  goal setting and plan •  strengths and weaknesses


Learning and Development Plan (PBL)

Met$Goal$ Level$Achieved$ Area$ Learning Need or Goal Identified by Method$to$Achieve$Goal$1st$qtr$ 2nd$qtr$ 3rd$qtr$

9/23/15

X

X

X

1,4 General Cardiology 1. Cardiac exam and assessment 2. NSTEMI/STEMI management 3. Endocarditis

S, P, E S, P, E S

CP SS • Present ACS cath case studies • Practice assessment techniques and

correlate with CXR/CT findings. • Review Endocarditis ACC guidelines

9/23/15

X X x

X x

1,4 Diagnostics 4. Echocardiogram Interpretation and key values 5. CXR/CT Studies interpretation 6. Nuclear studies interpretation 7. Pulmonary function testing 8. Valvular,mass assessment (11/26/14)

S, P, E S, P, E S S

IPE, SS, CP , L 9. Attend FCU Course 10. Attend CT/MRI lecture series 11. Review CXR/CT studies ordered on

patients seen with radiologist 12. Differenitate between

myocarditis/pericarditis using a case study presentation at a CNPF conference

13. Incorporate nuclear studies in cardiac stress diagnostic presentation

14. Attend PFT lecture; review PFT loops on patient seen in clinical setting

5/6/15 X x

1,4 Vascular 15. Aortic Aneurysm 16. Coagulapathies

S S, E

CP, SL, FP • Attend Novel Anticoagulant lecture L • Compare different clinical assessment and

management between venous and arterial occlusions CP

• Present vascular case studies incorporating coagulopathies, venous an arterial occlusions at a CNPF conference in January. Develop and present lecture with mentor. CP. FP

9/23/15

x

1,4 Interventional 17. Cath Lab diagnostics and interpretation

S, P, E

CP, SL, FP • Present case studies including

hemodynamics for a RHC/LHC/aortic valve assessment at Interventional rotation CNPF conference in March FP

• Review resources for hemodynamic studies

• Review coronary anatomy and cine views prior rotation

1 1,4 Electrophysiology 18. Antiarrhythmic medications 19. EP Catheter Ablation 20. EP Studies Interpretation 21. Pacemaker/ICD therapy 22. Syncope

S, P, E S, E S S, E S, E

L, CP • Attend EKG course by Program Director;

L • Teach a basic 12lead EKG course with

Crisity to RN/NP/PA staff or conference FP

• Use MUSE system during EP rotation to preliminary read hospital EKG; ask experts for guidance


Practice Based Learning Exercise

Concrete (Feeling)

Reflective (watching)

Active (doing)

Abstract (thinking)

1. 1. 1. 1.

2. 2. 2. 2.


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Nursing Professional Development (NPD)

•  Presentation

•  Publications

•  Research

•  Legislation


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Quality Outcomes (QO)

•  NPF •  Learning Plan •  Mentor Evaluations •  Conferences

•  Program •  Mentee Evaluations •  Retention

•  Profession •  Abstracts •  National recognition


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Quality Outcomes (QO)


Outcomes/Evaluation Exercise

Area of focus How to Evaluate Learner 1. 2. Program 1. 2. Profession 1. 2.


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Curriculum Design Take Home Points

•  What are your institutional goals?

•  What is the NPF role?

•  What are the optimal learning methods?

•  How will you evaluate success of the learner and program?


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“Two roads diverged in a wood, and I— I took the one less traveled by,

And that has made all the difference” -Robert Frost

Questions

Contact: [email protected]


References

•  Bandura, A. (1977). Self-efficacy: towards a unifying theory of behavioral change. Psychol Rev, 84(2), 191-215.

•  Barton, T. (2006). Clinical mentoring of nurse practitioners:the doctors’ perspective. British Journal of Nursing. 15(15), 820-824.

•  Cosme, S. (2015) Residency and Fellowship Programs for RNs and Advanced Practice RNs. Journal of nursing administration react-text: 44 45(9):416-417

•  Flinter, M. (2011). From new nurse practitioner to primary care provider: Bridging the transition through FQHC-based residency training. The Online Journal of Issues in Nursing, 17(1), 1-11.

•  Goudreau, K., Ortman, M., Moore, J., Aldredge, L., Helland, M., Fernandes, L., and Gibson, S. (2011). A nurse practitioner residency pilot program: A journey of learning. Journal of Nursing Administration, 41(9), 382-387.

•  Grossman, S. (2013). Mentoring in nursing: A dynamic and collaborative process. New York: Springer Publishing.

•  Harrington, S. (2011). Mentoring new nurse practitioners to accelerate their development as primary care providers: A literature review. Journal of the American Academy of Nurse Practitioners, 23, 168-174.

•  Hayes, E. (1998). Mentoring and self-efficacy for advanced practice: A philosophical approach for nurse practitioner preceptors. Journal of the American Academy of Nurse Practitioners, 10(2), 1-5.

•  Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ.: Prentice-Hall.

•  Ladyshewsky, R. (2010). Building competency in the novice allied health professional through peer coaching. Journal of allied Health, 39(2), e77-e88.

•  Omer, T., Suliman, W., Thomas, L., and Joseph, J. (2013). Perception of nursing students to two models of preceptorship in clinical training. Nurse Education in Practice, 1-6.

•  Ryan, R. and Deci, E. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development and well-being. American Psychologist, 55(1), 68-78.

•  Witt, J., Colbert, S., and Kelly, P. (2013). Training clinicians to be preceptors: An application of Kolb’s theory. Journal for Nurse Practitioners, 9(3), 172-176.