Using Nursing Outcomes Classification System NOC®

Taxonomy

1 Deborah Tibbs RN, MSN, BC, CCM

Miami University S10

  Nursing student(s) in their first clinical experiences often lack self-confidence and do not recognize the positive impact of their interventions with patients.

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 2

  Therapeutic Communication:

  Confidence:

  Clinical Judgment:

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 3

  Developing Learning Objectives   That could be met in any clinical setting   That could be implemented with any patient   Maintaining efficient course design to maximize

faculty work flow with numerous students

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 4

  Course design that assists student(s) to teach-learn in the clinical setting:   Key information about prescribed medication   Adult-learning principles   Key components of effective teaching   Meets regulatory standards for the health-care

agency

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 5

Assessment

Nursing Diagnosis

Expected Outcomes

Nursing Interventions

Evaluation

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 6

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 7

Evaluation

Synthesis

Analysis

Application

Knowledge

Daun (2006)   Evaluation of nursing student(s) learning

outcomes:   showed 47.3% of evaluation materials were at the

knowledge level   Only 6.5% were at the complex level of analysis

NCLEX-RN licensure exam reflects higher order thinking beyond analysis!

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 8

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 9

Verbal Information

Intellectual Skill

Cognitive Strategy

Attitude

Motor Skill

  Daun (2006)   Is more commonly know as an Instructional Theory   Based on classification of learning outcomes   Constructs learning hierarchy   Utilizes internal and external conditions necessary to

achieve learning outcomes   Focuses on the 9 prerequisites necessary in order for

delivering a unit of instruction

Gagne’s taxonomy encompasses higher levels of cognitive processes but doesnot fit the dynamic flow of nursing process

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 10

Patient Outcomes

Health Status Satisfaction

Discipline Specific

Provider Factors

System Factors

Patient Factors

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 11

  Standardized Language   Uniform Nursing Data Sets   Evaluation of Nursing Care Quality and

Effectiveness   Evaluation of Nursing Innovations   Participation in Interdisciplinary Care   Contributes to Knowledge Development

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 12

  Includes levels of abstraction in the Taxonomy   Most Level Abstraction-Domain   High Level Abstraction- Class   Middle Level Abstraction- Outcome   Low Level Abstraction- Indicators   Empirical Level – Measurement Activities

Allows for evaluation and reflection and revision to the teaching-learning experience

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 13

  Domain   Class

 385 Outcome(s) with definitions  Outcome Target Rating Scale

 Primary Behavioral Outcomes  Secondary Behavioral Outcomes

 Nursing Sensitive Indicators

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 14

  Functional Health   Physiological Health   Psychosocial Health   Health Knowledge and Behavior   Perceived Health   Family Health   Community Health

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 15

  26 classes   Examples:

  Mobility   Self-Care   Sensory Function   Satisfaction   Health Knowledge & Behavior

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 16

  Currently 385 Outcomes   Describe the individual, family, community state,

behavior, or perception that is measured along a continuum in response to nursing interventions

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  Knowledge: Health Behavior   Knowledge: Health Promotion   Knowledge: Medication   Self-Care: Non-Parenteral Medication   Self-Care: Parenteral Medication

  Describes the specific patient state that is most sensitive to nursing interventions and for which measurement can be defined

  The change in rating can be measured at different points in time and compared to baseline

  Can be used to set goals and assessed over time

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 19

  Identifies correct names of medication   Appearance of medication   Medication therapeutic effects   Potential Medication interactions

  Food-drug   Drug-drug

  Correct use of Medication   Dose   Frequency   Missed dose

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 20

  Uses 14 different scales to measure outcomes in a 5 point likert scale

  Examples:   None-Extensive   Not adequate-Totally adequate   10 and Over-None   Not at all Satisfied – Completely Satisfied   Never demonstrated –Consistently demonstrated

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 21

Student:   Develop a teaching-learning plan for a class of

medications   Identify all medications in assigned class   Identify the NOC® outcome, domain, class,

and nursing sensitive indicators , and scale necessary to measure nursing interventions

  Teaching-learning plan will reflect adult learning principles

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 22

Student   Identify a target rating goal   Identify patient baseline and post-teaching

rating   Student will show evidence of revision to

teaching based on client response   Self –evaluation and reflection of evaluation of

teaching effectiveness, strengths, and weakness, and what could be improved.

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 23

Faculty   Instruct on the use of NOC® including

assigned reading   Supply the format of the NOC® tool   Define the grading rubric   Define how each student is implement,

evaluate and reflect on the teaching-learning assignment in the clinical setting

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 24

Therapeutic Communication:   When implementing the medication teaching -

learning assignment the student will be able to identify client problems and make immediate changes in the teaching plan of care to promote positive outcomes

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 25

Confidence:   On completion of the teaching-learning

assignment the student will verbalize heightened comfort and self-confidence with teaching clients through self reflection of strengths and weakness and analysis of outcome data

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 26

Clinical Judgment:   After implementation of the medication

teaching-learning assignment the student will demonstrate and understanding of the NOC system and the effectiveness of the individualized patient teaching-learning plan

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 27

Handout!

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  Average Baseline Rating Score 2.69 reflects Limited Knowledge   Minimum 1.0   Maximum 3.78

  Average Post-teaching Rating Score 4.42 reflects Substantial Knowledge   Minimum 3.67   Maximum 4.7

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 29

“Not feeling like every second needs to be filled with words”.

“I think the communication we shared helped the teaching be more successful”.

“ I talked way too fast, next time I will slow down”.

“ I was not careful in my wording and could have offended the patient, so I need to choose my words more carefully”.

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 30

“ When I first walked in the room I felt like I just needed to get this over with, but once I began teaching it just started flowing. I became more client centered.”

“Next time I will be more laid back and not so nervous”.

“As poorly as I think I did, my patient learned a lot about his medication increasing his NOC score from 1.78 to a 3.67”.

“I relied heavily on NOC indicators to guide me”. Deborah Tibbs RN, MSN, BC, CCM

Miami University S10 31

“I recognized how my teaching plan would have been foiled if the client had not been as alert. Always have a plan B”.

“I should have used more repetition on concepts the client had trouble with”.

“I remained standing the whole time. I believe this interfered with connecting to the client”.

“I would allow the patient more time to read the handout”.

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 32

  Detailed assignment/grading rubric   NOC® Measurement Tool Template   Self-reflective Paper

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  Students struggled with the complexity and number of NOC® outcomes and had difficulty choosing the correct outcome for the assignment.

  Student struggled with the difference between nursing sensitive indicators and nursing interventions

Deborah Tibbs RN, MSN, BC, CCM Miami University S10 34

  Have practice sessions in post clinical conference using NOC® to evaluate their interventions implemented that clinical day.

  Spend more time discussing NOC®

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Handout!

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Angelo, T., Cross, P. (1993) Classroom Assessment Techniques A Handbook for College Teachers. San Francisco, Ca: Jossey-Bass.

Bambini, D. (2009) Outcomes of Clinical Simulation for Novice Nursing Students: Communication, Confidence, Clinical Judgment. Nursing Education Perspectives, 30 (2), 79-82.

Brown, S. T., Kirkpatrick, M. K., Greer, A., Matthias, A. D., & Swanson, M. S. (2009). The use of Innovative Pedagogies in Nursing Education: An International Perspective. Nursing Education Perspectives , 153-158.

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Gagné, R. M., & Gagné, R. M. (1985). The conditions of learning and theory of instruction. New York: Holt, Rinehart and Winston.

Larkin, B., Burton, K. (2008) Evaluating a Case Study Using Bloom’s Taxonomy of Education. AORN Journal, 88(3), 390-402.

Moorhead, S., Johnson, M., Maas, M., Swanson, E. (2008) Nursing Outcomes Classification (NOC) Kidlington, Oxford: Mosby Elsevier.

Morrison, R. S., Burroughs, C., Witt, M., Redden, J., & Leeper, J. D. (2000). Evaluation of NOC instruments with chronically ill patients. Southern Online Journal of Nursing Research, 1 (1).

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Murphy, J. I. (2004). Using Focused Reflection and Articulation to Promote Clinical Reasoning. Nursing Education Perspectives , 226-231.

Richlin, L., (2006) Blueprint for Learning Constructing College Courses to Facilitate, Assess, and Document Learning. Sterling, Va.: Stylus Publishing.

Yan, D. (2006) Selecting and Applying Taxonomies for Learning Outcomes: A Nursing Example. International Journal of Nursing Education Scholarship, 3(1): 1-14.

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