Michelle M. Byrne RN, PhD, CNOR Kathryn Schroeter RN, PhD, CNOR Portfolios: Implications for perioperative education, evaluation & competency Assessment Michelle M. Byrne RN, PhD, CNOR Kathryn Schroeter RN, PhD, CNOR

CCI Research Committee: Michelle Byrne, RN, PhD, CNOR - Chair Kathryn Schroeter, RN, PhD, CNOR – CCI Board Liaison Teresa Delarose, RN, MN, EdD, CNOR Cecil A. King, RN, MS, CNOR, APN Jane Leske, RN, PhD, APRN-BC Nancymarie Philips, RN, MSEd, CNOR Kathryn G. Sapnas, RN, PhD, CNOR, CCRN

What do you think of when you think of a portfolio?

Portfolio - formal definition Mechanism for evaluation of competencies that may otherwise be difficult to assess, such as practice-based improvements, use of scientific evidence in practice, professional behavior and creative endeavors.

Artist Portfolio Contents Artistic products demonstrating a variety of media, foci, and technique. External review by peer or faculty

Teacher Portfolio Contents Academic credentials Faculty and peer evaluations Research and publications Service to institution or community Student evaluations Course materials-syllabi & assignments.

Student Portfolio Contents Progressive learning. Skill checklist Best exemplars of work. Development of self assessment skills. Reflective learning. Faculty evaluations.

Physician Portfolio Contents Course completion or contact hours Certificate requirements Licensing requirements Residency/fellowship applications Peer evaluation Publications and research

Portfolios Dynamic and offer a fuller and richer image of the individual than paper and pencil evaluation tools.

Informal definition: A Portfolio is a Scrapbook of your career Photos Work products Educational offerings or attendance Annual evaluations Letters from employers or patients

Your Portfolio! Mentoring / Precepting Perioperative Care Plan Continuing Education Standards & Recommended Practices CQI Clinical Pathway

Domains of Perioperative Nursing Based on Perioperative Job Analysis Perioperative Nurse Competency Continuum Study Involvement of Task Force CNOR’s Thomson Prometric staff

Domains of Perioperative Nursing Patient assessment & Dx Identify expected outcomes & develop plan of care Intraoperative activities Communication Discharge planning

Domains of Perioperative Nursing Cleaning, disinfecting, packaging & sterilizing Emergency situations Management of personnel, services, & materials Professional activities

Types of Professional Activities Nursing care planning Clinical pathway development/utilization Development of educational resources Personal continuing education Application project re: AORN standards or PNDS Continuous quality improvement project Evidence-based practice initiative

Types of Professional Activities Risk management activities Mentoring / Precepting roles Leadership role Educational presentations Professional writing Academic course completion

Reflective Learning Reflection is the process of learning from experience. Reflection allows you to use your experience to determine what you may do differently as a result of the learning. Reflection aids ongoing self-assessment & ensures your learning is current and relevant to your practice.

Reflection Narratives Thoroughly describe the activity/ project/ event. What happened or occurred? Clearly describe your role. What do you know now that you did not know before?

Reflection Narratives What have you learned? What would you do differently? How will you build on this experience? What are the implications for perioperative nursing practice?

What’s in your portfolio?

Contributions to professional organizations Local chapter AORN State Nursing Association Sigma Theta Tau

Educational Presentation Staff workshop AORN chapter continuing education Staff orientation (At least three 1 hour presentations are required) Include time/date of presentation, objectives, outcomes, topic outline or handouts, learner evaluations.

Evidence Based Practice Provide examples of how research findings were used to validate or change your practice. Risk management Research utilization Research participation Policy/Procedure involvement PNDS

Professional Writing AORN Journal article Specialty assembly newsletter article Employer publication Chapter newsletter Letter to the editor

Educational resources Patient education guide Employee guide Perioperative inservice Instructional forms

Continuing Education Narrative of HOW continuing education changed your practice. “After attending this conference, I have an increased awareness of fuel sources and how flammable prep agents are. I am much more verbal in communicating with other team members about the importance of letting prep solutions dry before giving the cautery to the surgeons.”

Application of Recommended Practices or PNDS How was this used in your professional practice? Policy/procedure creation or revision Medical legal cases

Academic Courses Related to perioperative nursing Either taught or taken—provide syllabus / grade Examples: Specific or general

Precepting / Mentoring Provide a narrative including name(s) / credentials of those whom you precepted or mentored along with contact information for a registered nurse colleague who can verify that the information is true and correct. Students, new staff, faculty, etc.

Nursing Care Plan Provide a nursing care plan that you have developed or modified that illustrates how you were able to individualize a plan of care based on assessment data. Safety protocols, reporting, communication, environmental control, documentation, etc.

Clinical Pathway Provide a copy of a clinical pathway for which you have participated in the development, revision or utilization for a specific patient population.

Continuous quality initiative Provide an example of a continuous quality improvement plan that you developed or participated in that improved perioperative patient care & outcomes. Survey data utilization Provision of technical assistance on a surgical product or new technology

Certification is linked to continued competency.

Continued Competency Defined as the application of knowledge and the interpersonal, decision-making, and psychomotor skills expected for the nurse’s practice role, within the context of public health and safety. (NCSBN 1996, 1998)

Why continued competency? Institute of Medicine (IOM): Mandate to reduce patient errors. Rate of change and information explosion demands ongoing learning from professionals.

Do you believe that CE guarantees competency? The Current Common Competency requirements for nursing licensing boards is continuing education. Do you believe that CE guarantees competency?

How does one demonstrate learning? It’s more than just sitting at an educational session at a conference… “You don’t know what you don’t know” “Remember what it was like to not know what you now know” “It was good enough when I graduated…”

ANA Code of Ethics (Provision 5) The nurse owes the same duties to self as to others, including the responsibility to preserve integrity & safety, to maintain competence, & to continue personal and professional growth.

PEW Task Force on Health Care Workforce Regulation Performance monitoring Proctoring Simulation Continuous clinical practice evaluation

Monitoring may include: Chart review Evaluation of clinical practice patterns Simulation Proctoring External Peer Review

Portfolio Evaluation/rating process Credibility Dependability Confirmability Adequacy and appropriateness of data Multiple raters

Portfolio Review Evidence will be reviewed and judged as meeting or not meeting criteria. Two raters-third if disagreement. Reviewers-CNORs

Assessment or Evaluation Formative (professional growth and development) Vs Summative (final evaluation of criteria met/unmet)

Portfolios-Developing a process for CNOR recertification/reactivation Personal accomplishment Accountability Personal satisfaction Professional credibility Consumer confidence Recognition from others Marketability

CCI Initiatives Publish information on portfolio utilization in competency assessment Pilot the portfolio project in 2007 Plan to implement the portfolio for recertification and reactivation of CNOR credential in 2008.

For creator and evaluator! Portfolios: Tips Time consuming — For creator and evaluator! But it doesn’t have to be!