Standard 2 Aspect E

Standard 2: Program completers engage in professional practice in educational settings and show they have the skills and abilities to do so in a variety of additional settings and community/cultural contexts. Establish goals for their own professional growth and engage in self-assessment, goal setting, and reflection.

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Setting professional goals can be a challenge to nurses who are task oriented by training.  Self evaluation of one’s own practice may be especially difficult if one is the only nurse in a district. The school nurse must design goals and objectives based on the perceived needs of the school community and continuously evaluate effectiveness of the goals and objectives in a systematic way.  Once a school nurse has earned her credential, she must continuously stay on top of the latest health related standard of care for students, staff and the community to be effective.  Collaboration with other school nurses allows an exchange of ideas and standards.  As a part of the SNSC program curriculum the school nurse candidates are encouraged to join professional organizations, set yearly goals and take time to reflect on their practice. In addition, candidates set personal learning goals and objectives when entering the program, continuously evaluate practice in all courses and are asked to evaluate their final knowledge levels in the Knowledge Based Questionnaire at program's end.

DATA Sources to be Introduced:

• Pre and Post Knowledge Based Questionnaire (Form Pre KBQ and Post KBQ)
• N186 and N187 Course Assignment: Personal Learning Goals and Objectives 
• Self-Evaluation of Program Effectiveness at Program Completion 
• Professional Dispositions (Form P104/P204)
• Employer/Supervisor Survey of Program Effectiveness (Employer/Supervisor Survey)
• Nursing 186 and N187 Practicum - Experienced Nurse Project/Leadership Project 

Data Source 1

Program Start and Completion of Knowledge Based Questionnaire 
The first measure is a student self-rated questionnaire measuring the knowledge candidates have at program entrance and after program completion. Participants, who have on average at least two years of school nursing experience entering the program, rate their level of knowledge of school nurse practice before entry and after program completion using a Likert-type scale of 5 (very knowledgeable) to 1 (no knowledge). Scores on the KBQ allow the students to see areas where they lack knowledge to help with designing their personal Learning Goals and Objectives for the program practicums. For example in 2019, candidates entered with high knowledge scores in Child Abuse, Immunization compliance, and Children with Special Needs but stated they had little knowledge of Nursing Theory, School Refusal/Absenteeism, Drug Exposed Infants, and Neurological Testing. 

Following the questionnaire, students develop individual goals and objectives based on their learning needs. 

The purpose of this approach is: 

1. To determine the knowledge base of candidates entering the program allowing candidates to design their program experience around areas of the greatest lack of knowledge. 
2. To determine if program participants showed significant gains in their knowledge level. 
3. To determine areas of the program content needing strengthening. 
4. To determine if the program addressed the current needs of school nurse professionals. 
5. To establish a basis for candidate individualized Professional Goals and Objectives.

Pre-Post Knowledge Base Questionnaire Ratings

For the chart below, 1-30 is the specific knowledge or skill area, and 0-80 is the candidate's self-rating of that knowledge.

• _{(Pre and Post KBQ)}

Data Source 2

N186/187 Course Assignment - Personal Learning Goals and Objectives: 
After the self-review of the Pre-Knowledge Based Questionnaire students are asked to reflect on areas of needed growth. In Nursing 186, candidates design personal goals and objectives for the practicum experience. Personal goals and objectives are reviewed mid semester and at the end of the semester. New goals and objectives are designed for Nursing 187 second semester, with a focus on secondary education.

• _{(N186 Syllabus)}
• _{(N187 Syllabus)}

Perspective: Candidate

Sample Responses from Students:

As stated by one candidate:
“ I believe the Fresno State School Nurse Credential Program did give me the tools to meet all learning goals and objectives.  In comparing my answers in the pre and post knowledge survey, I scored myself much higher in the post survey in practically all areas of the school nursing profession and needed knowledge.” 

“In the future I want to  make sure to keep up with the changes to state education bills and mandates for school health. These change frequently and new ones are presented and passed so it is important to keep up on this throughout my whole career no matter how long it may be.  I want to continue to grow in all areas of school nursing.  I hope to continue to strive to become the best school nurse I can possibly be and serve my students and families well. “ 

Examples of candidate end of program self evaluation - “In the Future I plan…”

• “Future increased involvement with other disciplines to improve healthcare”.
• “Professional certification as a CPR educator”.
  “Obtain an Administrative Credential.”
• “Increased involvement with mental health areas.. working to design a mental health education program for the elementary setting.”
• “To keep learning, attend state SN conferences, increase knowledge in program management.”
• “Improve health care delivery for students with mental health issues.”
• “Utilize technology to educate students and families in the community.”
• “Create online educational tools for my district.”

_{(Evaluation statements)}

Mean GPA in courses with reflection to practice/development of personal goals

Data Source 3

Professional Dispositions (P104/P204)
The second measure is used by practicum preceptors to measure candidates' dispositions or behaviors using a 5-point Likert Scale.  Preceptors are asked to: “Circle the number on the scale that reflects the most accurate description of student application of dispositions.”

Perspective: Preceptor

Rationale for Using: 
Professional Dispositions measures behavior needed for successful practice.  The expectation is that if candidates exhibit these dispositions while in the program, they will also exhibit these dispositions when they are in the field.

Specific Items Used for Analysis:

• Item 1:  Candidate demonstrates the ability to reflect. (A broad knowledge base, empathy and altruism are developed through parallel focus on experience and reflection.
• Item 6:  Candidate demonstrates their enthusiasm for Life-Long Learning. (Professional integrity is routed in commitment to life-long learning about ones profession and beyond.

Definition of Success: 
This measure is a 5-point Likert scale with Excellent to Poor ratings.  Our goal is 100% of the candidates will measure an Excellent or Very Good on Dispositions. 

• _{(Professional Dispositions Means)}
• _{(Professional Dispositions %)}

Summary of Findings 

From 2017-2020:
Preceptors perceive that 99% of the SNSC Candidates demonstrate the ability to REFLECT by scoring an Excellent or Very Good.  Two candidates scored Good. Zero candidates scored Fair or Poor.

In addition, preceptors rated 97% of candidates with the ability to demonstrate enthusiasm for LIFE LONG LEARNING Skills by scoring an Excellent or Very Good.  Three candidates scored Good.  Zero candidates scored Fair or Poor.

• Mean range is 4.83 to 4.93 with an average mean of 4.87 in ability to REFLECT.
• Mean range is 4.82 to 4.92 with an average mean of 4.88 in enthusiasm for LIFE-LONG LEARNING.

Analysis and Interpretation
Preceptors scored high marks in the ability of SNSC candidates to reflect on their experience and candidates demonstrated enthusiasm for life-long learning by setting personal learning goals and designing experiences to promote self-learning.

Data Source 4

Employer/Supervisor Survey of Program Effectiveness
The Employer/Supervisor Survey of Program Effectiveness is given to District Health Services Administrators who supervise program candidates in the workplace. These aspects look at how the program prepares candidates in assessment areas to improve and support a students’ ability to learn. This is mailed out one year after a candidate completes the SNSC program. Supervisors are asked to: “Rate the following program standards related to the program’s effectiveness in preparing professional school nurses.”

Perspective: Employer/Supervisor of Program Completer

Specific Items Used for Analysis:

• Standard 3: Relationship between Theory, Research and Practice
  By design, the program provides a variety of opportunities for candidates to reflect, analyze, and implement the relationships between learned theory and evidence-based practice in clinical experience. Evidence indicates candidates examine nursing, education, other theories and research, and their relationship to student health and wellness; school and community health; and student achievement. 

Definition of Success:
The SNSC program is rated on a 4-point Likert scale with 4 representing Excellent to 1 representing Poor.  Our goal is supervisors will rate the program a minimum of 3. 

(Employer/Supervisor Survey)

Summary of Findings 
Program Standard 3:  100% of district administrators stated the SNSC program was rated Excellent or Good when it comes to providing opportunities for candidates to reflect on learned theory and evidence-based practice in clinical experiences in 2016 and 2020.  Zero Administrators scored the program Fair or Poor. 

Analysis and Interpretation
In 2016, 55% of administrators indicated the SNSC Program provided opportunities for candidates to reflect on learned theory and evidence-based practice in clinical practice.  In 2020, the score rose to 77%. In Nursing 186 and 187 curriculum there is evidence via journal entries and assignments indicating candidates examine nursing, education, other theories and research, and their relationship to student health and wellness; school and community health; and student achievement. This has not changed. However, the SNSC program coordinators have spent additional time educating program advisors, preceptors, and administrators regarding program standards and encouraged additional candidate support. This additional education to stakeholders might be one reason for the increase in positive perception.

Data Source 5

Nursing 186/Nursing 187 Leadership Role Paper or Experienced Nurse Project
School Nurse Services Program candidates have the opportunity to polish professional knowledge and skill in a required on-site practicum of 80 hours in Nursing 186 and Nursing 187 for a total of 160 hours.  Working with a preceptor school nurses experience supervised hands-on application of the information and skills learned in the seminar courses.  School Nurses design Professional Goals and Objectives to further professional knowledge and as one of the three goals and objectives may choose a Leadership Role or Experienced Nurse Project.  

Perspective: Program Faculty

Definition of Success: A C grade is required to pass the course and a 3.00 for the program. Experienced Nurse Project/Leadership Project

Mean Grades in School Nurse Practicum Courses

Analysis and Interpretation
Data shows SN candidates achieved high ratings in fall and spring practicums from 2017-2018 with mean averages of 3.87 and 3.91.

Analysis of Standard 2e Findings
Evidence overwhelmingly demonstrates school nurse candidates establish goals for their own professional growth and engage in self-assessment, goal setting, and reflection to improve practice.

SNSC candidates establish personalized learning goals and objectives, reflect on personal growth using journal entries, and design Leadership/Experienced Nurse Projects as verified by employers and preceptor observation and ratings.  This indicates the School Nurse Credential Program candidates understand, design and implement professional goals related to the provision of school nursing. 

Aspect F →