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A major difficulty instructors have, regardless of setting, is changing from the traditional perspective of writing and using behavioral objectives to more contemporary competency outcomes as the blueprint for basic and advanced learning and practice of the discipline. Outcomes are the results to be attained, the end product, the focus of all related activities; they require learners to engage in and become competent in skills used in practice. Objectives, on the other hand, as commonly used, focus on ways of learning and directions for learning the content. Most often they do not reflect practice-related abilities for which the content is to be learned. This section explores the guidelines and process of writing outcome statements and making this fundamental transition; some examples are cited for a variety of levels and competencies. Even competencies such as cultural competence, perceived by many to be more difficult and challenging, can be written as an outcome statement with critical elements for diverse types and levels of students, practitioners, and/or organizations, as seen in Figure 2 (Lenburg, et al, 1995).
| Figure 2. Examples of Nursing Skills and Related Critical Elements |
Administer Medications: The administration of parenteral and non-parenteral medications to clients between 2 and 10 years of age in designated clinical setting.
By the conclusion of this course (module), the student will be able to:
Calculate fractional dosage consistent with standards of practice, using body surface area or child’s weight to verify safe range of dosage
Administer the prescribed dose of medication to designated patient, using prescribed route, within +/- 30 minutes of prescribed time
Administer medications to children using technique consistent with patient-related data and medication standards
Monitor patient response to medications within 15-20 minutes of administration
Document administration of medication according to agency protocol (or, exam record forms, as pertinent)
Incorporate cultural competence skills in clinical practice: The integration of diverse aspects of cultural values and preferences for clients, related others, and peers.
By the end of this course, the student will be able to:
- Show respect for diverse values and preferences of other individuals and groups
- Take action to learn about cultural variations and values in others
- Integrate knowledge of cultural variation into professional practice
- Take action to change negative and prejudicial behaviors in self and others
Critical Thinking in Case Management:
Plan a study to investigate differences in variance for a designated protocol among patients with similar conditions (eg, DRG classification)
At the designated time, the case manager will:
- Write the specific question to be explored, including related components
- Write the justification for investigating the specified problem
- Describe methods to be used, including subjects, timeline, and methods of data collection and analysis
- Develop a budget that is adequate and efficient for the purpose
- Outline potential consequences of positive and negative findings
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Examples of converting objectives to outcomes.
The following example of unit objectives was extracted from an actual college-level course syllabus on Life Span Development. The stem reads: Upon completion of the units of the course, the student will be able to:
Unit I
- Discuss the relationship between individual and family development
- List and describe the 7 parameters needing consideration in conducting a systematic family assessment
Unit II
- A.&coparef.htm#9;Discuss the developmental tasks of the marital dyad
These objectives are traditionally written but have little to do with actual practice, or nursing competence. "List" and "discuss" may give direction for learning certain basic aspects of family assessment and development, but they do not correspond to competencies nurses actually use in practice. As worded it is difficult for the learner to know what the result, or outcome of the learning should be, what abilities they are aiming for, and how such learning activities relate to professional practice. In a competency-based system objectives like these are converted to practice outcomes, in response to the fundamental questions: What do nurses actually do in practice with the information studied in this course? How is knowledge used to help clients deal with real situations of illness or promoting health?
In determining competency outcomes, the realistic answers to some basic questions are required. What is the student expected to be able to do (in cognitive, affective or psychomotor performance) as a result of the course? Will the student write about, or actually perform some activity based on the knowledge? Is the knowing the end outcome, or engaging in nursing activities using the knowledge the competence to be achieved? Verbs such as describe, discuss, identify, list, and explain usually only require knowledge as the outcome. They could be changed to specify active engagement, such as: apply, integrate, implement, differentiate, or formulate. It is essential to determine what performance or competence is expected at the end of the pre-assessment period, the extent to which it is expected, and under what conditions it is to be demonstrated. The outcome statements then are written accordingly.
The unit objectives are rewritten below to illustrate evolving thinking and final wording as practice outcomes. Focus on the undergirding, but unstated competence used in practice, and consider how the objectives could be rewritten as competency outcomes.
Unit I
- Apply (or use)
theories about family and family development as the basis for conducting a family assessment (Is the highest level of competence to apply theories? Or is it to: )
- Conduct
a systematic family assessment using theories about family and family development as the basic framework (Nurses conduct assessments based on theories, information, and protocols.)
Unit II & III
- Explain
the differences in developmental tasks for expectant mothers and fathers, neonates, and infants (Is "explain" the highest level of performance expected? Or, for a more interactive and performance-based outcome, do nurses: )
- Plan
interventions to promote positive parenting by incorporating knowledge of the expectant childbearing family and developmental tasks of its members…. (Planning is an essential competence in practice and should be based on knowledge of various information data sets, standards, and protocols.)
The first suggested revisions (above) are examples of "cart-before-the-horse" thinking. Determine the skill to be emphasized at this level and put it first in the statement; this focuses content organization, learning strategies, and subsequent assessment methods. It also conveys to the student what competent practice actually includes and, therefore, what they must learn.
The following examples were extracted from other courses and illustrate the differences between traditionally phrased, course objectives and their conversion to competency outcome statements (revisions in italics). Unlike process-oriented objectives, outcomes are specific and performance-oriented competencies nurses actually use in practice; they are the results, the abilities, to be attained (outcomes) as a result of the learning experiences. The choice of verbs depends on the level and type of ability expected and the nature of the course.
- Describe the importance of nursing’s involvement in political action and shaping health care environments.
Engage in a health related political activity that promotes the importance of the nursing profession in creating change in health care environments.
- Demonstrate critical thinking, judgment, and cultural competence in applying community health principles into practice.
Integrate community health principles, critical thinking, reflective judgment, and cultural competence into community health practice.
- Demonstrate knowledge of wellness concepts as a basis for care provision.
Provide (or: Plan) care to children that incorporates concepts of wellness
Some Basic Criteria for Writing Competency Outcome Statements
In making the transition to a competency-based program, the perspective and language must be changed to practice-based outcome statements to be achieved by the learner as a result of the constellation of focused learning activities. The set of outcomes begins with the leading stem: "At the conclusion of the course (module, unit), the learner will be able to:". Each competency outcome statement is characterized as follows:
- It is worded as a learner-oriented, essential competence (psychomotor, cognitive, and/or affective) to be achieved by the end of the learning period. It is the highest level of competence expected at this level or for this module, unit, or course and subsumes lower level competencies.
- It is worded in clear, specific, unadorned, and concise language readily understood by the learner and teacher, and is measurable. It is action oriented and begins with the verb that most precisely describes the actual, preferred outcome behavior to be achieved.
- It is consistent with standards, practice and real world expectations for performance, i.e., what the practitioner (student) actually needs to be able to do.
- It contributes to the cluster of abilities needed by the student (graduate) to fulfill the expected overall performance outcomes of the agency or program.
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