Licensure Students through Study Skills Course

Strengthening Academic Performance in PreLicensure Students through Study Skills Course
Helen Gordon DNP, CNM, CNE, CHSE
Duke University School of Nursing
© The content of these slides are the property of Helen
Gordon @ Duke University School of Nursing and may not
be reproduced without written permission. Contact:
[email protected]
229,459
Grads + foreign trained nurses took NCLEX in 2015
166,523 (81.78%)
passed on the first attempt
62,936 (38.36%)
Retested, 1 or more times
Annual retest cost 1X
$12,587,200
Source: National Council State Boards of Nursing, 2016
2002
Duke School of Nursing + grant from the Helene Fuld
Trust began an ABSN Program
Graduated 1300+ students since 2003
Currently 124 students in 3 cohorts are
on campus
Admit 2X a year: Jan + Aug
Program approach to NCLEX
Student Tracking
Student
390
391
292
395 C
J Smith
R Jones
N Grey
C Henly
J Franks *
S Anderson
A Martin
AA
B
B+
B
B
A
A
B+
B+
AC
B+
A
A
A
AA
B+
AA
B
BB
A
BC
A-
395
ATI
2
2
2
3
0
1
3
396 C
A
B+
B
B
BC
B+
396
ATI
1
2
1
2
1
0
2
397 C
B+
B
A
B
C
B
A
397
ATI
2
2
3
2
1
2
3
students to ask questions as they develop
this assignment, dates TBA.
Quizzes: pop quizzes and sakai quizzesCLOSED BOOK, done weekly,
10%
REQUIRED.
Quizzes open on Friday morning and
close Tuesday night at 2300.
*This is on the honor code
ATI Skills Modules
s
Five (5) required ATI skills modules. They
are: IV Therapy, Medication Administration
4, Surgical Asepsis, Wound Care and Foley
Catheters.
Clinical reflections (required; not assigned
a letter or numerical grade). This is because
we want students to write their true
reflections, not write to the perceived
acceptance of the CI. There are 2 that are
required.
10 points each
Module for
completion
2 points,
counted as
a quiz
grade
Clinical presentation
18 points
Attendance in class & clinical +
mandatory CND lab experience
Required
ATI exam & Review
Possible 3 points for exam and 1 point
for each review exam= 5 points total.
Total
5%
100%
The due date for Part II is: February 19, 2016
by 12pm; please post to sakai
Being present in class, engaged + completing
the readings will contribute to success.
Two classrooms will be flipped. In this mode
there is a quiz when you come to class which is
individual and a group quiz. This will replace
your online quizzes.
You must complete: Pre & posttest, and log a
minimum of 30 minutes on each module in
order to receive the 10 points for that module.
If criteria are met, 10 points will be awarded, if
not, your score for that module will be 0.
Counted in the category of quiz grades.
Required, evaluated, 1:1 feedback.
Electronically submit to CI’s. This material allows
the CI’s to know you, and evaluate your progress &
clinical reasoning. One point assigned for each
reflection that is complete, well-written, and
turned in at the designated time.
Students are assigned a SMALL topic to present
in clinical conference at a designated point in
the clinical experience. 18 points are possible
and count as one quiz grade. A rubric is
provided. We expect you to spend no more than
1-2 hours preparing for this exercise. Added to
quiz grade.
There are no make-up clinical days. Students
who do not complete all clinical days will be
subject to a delayed progression in the
program, possible course withdrawal/failure.
ATI exam: Done in class; computer based. See
grid below for scoring. Counts 5% of final
grade.
Review exams done out of class, there are 2 of
them.
ATI
2 review exams + Final ATI = 5%
Critical that you read the ATI book
+ textbook & you READ as the
course progresses
Complete review exams and selfremediate what you do not know
Copy of the Orientation Slide to N395
Remediation Strategies
RX: for different issues
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Course faculty office hours (TeamT)
Exam reviews
Advisor coaching
1:1 Student tutoring (no cost to student)
Study skills coaching (Hg)
Self-remediation through ATI modules
5-10 NCLEX questions per day
Writing papers to the editor
CAPS for counseling + extended exam time
Learning Improvement Plan (LIP)
Evolution of the Study Skills Course
Study Skills Lecture (2012)
Remediation (Rx)
4 hour Study Skills Course
(2014)
Study Skills Course





3 hour course taught week 1 of program
Mandatory attendance
Pre-readings in ATI SS book before class
Each student is given a packet in class
4 topics are covered
 1 hr-follow-up after first exam to
determine individual and cohort “issues” *
* Follow-up information February 23, 2016
N= 74
Attack skills (7)
Help with multiple answer questions (7)
Overthinking questions (5)
Time management (3)
NCLEX practice questions (3)
Learning to use class objectives (3)
Reading questions (2)
Test anxiety (1)
Daily study (1)
Not changing answers (1)
Self-confidence on test taking (1)
Needs more “hands on” learning (1)
Study tips (1)
Course Framework
Time Management
Content
• Balancing competing priorities: Saying “NO”
• Diminishing procrastination
• Keeping a master calendar of assignments
and labs
• Learning to work ahead
• Organize study space and materials in
notebooks
• Master plan for time: class, clinical, lab,
family, self-care
• Goal setting for each course component
Study Skills Content
• Prepare for class-have “something at stake” (Krasnic)
• Skim the readings to ID “what you know and do
not know”
• ID the objectives of the class/lab period
• Take your own notes, do not use slide sets (Garr)
• Polish notes after class
• Make a “Do not know list”
• Read deeper after class what you do not know
• Review course content 20-30 minutes, per
course per day!
“REPEAT TO REMEMBER,
Remember to repeat” (Medina)
Stress Management
• 1st semester wellness course: Self
care portfolio
• Emphasis on building community
• On site yoga classes
• Running club
• Koru Mindfulness classes for young
adults
• Counseling & Psychological
Services: extended testing, anxiety,
family issues
Exam Skills
• Attack Skills for multiple choice +
multiple answer questions
• Exam Reviews
• Self-remediation
• NCLEX Practice questions (Saunders)
• REACHING OUT: Effectively using faculty
office hours + advisor
Attack Skills
1. Read the entire question without looking at the answers
2. Highlight key words: best action, highest priority, first
action, goal
3. Reformulate the question
4. Formulate an answer
5. Now look at the answers & choose the correct answer
Special note: If you know you change answers, STOP IT!
Attack Skills Example 1
Multiple choice
Q. A woman has been transferred to the PP
unit from L&D; she gave birth vaginally, 2
hours ago. Which of the following nursing
care goals is the highest priority for the PP
nurse?
1. Read the entire question
2. HIGHLIGHT KEY WORDS
A woman has been transferred to the PP unit from
L&D; she gave birth vaginally, 2 hours ago. Which of
the following nursing care goals is the highest
priority for the PP nurse?
A woman has been transferred to the PP unit from L&D; she
gave birth vaginally, 2 hours ago. Which of the following
nursing care goals is the highest priority for the PP nurse?
3. Reformulate the question using the key words
NEW QUESTION
What is the highest care goal for a
woman who is 2 hours PP?
4. Possible correct answers
Key fact they must know: “Uterine atony is the #1
killer of women in the world/”
• Something to do with not bleeding
• Keeping the fundus firm & midline
• The lochia small to moderate
• Massaging the fundus
A woman has been transferred to the PP unit from L&D; she
gave birth vaginally, 2 hours ago. Which of the following
nursing care goals is the highest priority for the PP nurse?
What is the highest nursing care goal for a woman who is 2 hours PP?
A. The woman will successfully ambulate to the
bathroom.
B. The woman will successfully breastfeed her
infant.
C. The woman will tolerate a regular diet.
D. The woman will have moderate lochia.
**Only answer that has a connection to the uterus/bleeding
Attack Skills Example 2
Multiple answer question
For 30 hours after the birth, the baby’s temperature has
remained normal. The nurse does the assessment and
the temperature is significantly lower than it was 4 hours
ago. The baby is lethargic, pale and does not want to
breastfeed. Which of the finding from the mother’s L&D
record should the nurse consider as a possible link to the
baby’s behavior?
1.Read the entire question.
2. Highlight key words
For 30 hours after the birth the baby’s temperature
has remained normal. The nurse does the
assessment and the temperature is significantly
lower than it was 4 hours ago. The baby is
lethargic, pale and does not want to breastfeed.
Which of the finding from the mother’s L&D
record should the nurse consider as a possible link
to the baby’s behavior?
For 30 hours after the birth the baby’s temperature has
remained normal. The nurse does the assessment and the
temperature is significantly lower than it was 4 hours ago.
The baby is lethargic, pale and does not want to breastfeed.
Which of the finding from the mother’s L&D record should
the nurse consider as a possible link to the baby’s behavior?
3. Reformulate the question using the key
words
What might have happened in the intrapartum
period that is recorded in the mother’s L&D record,
that could impact the baby’s health, 30 hours
later?
Answers students listed:
1. She is GBS positive and did not get treated in labor
2. She is diabetic and the PP nurse did not know (IDM)
3. Her membranes ruptured > 24 hours before the birth
4. She has herpes
5. She is an addict
This is the list, now look at the answers:
For 30 hours after the birth, the baby’s temperature has remained normal.
The nurse does the assessment and the temperature is significantly lower
than it was 4 hours ago. The baby is lethargic, pale and does not want to
breastfeed. Which of the finding from the mother’s L&D record should the
nurse consider as a possible link to the baby’s behavior?
POSSIBLE ANSWERS
A. The baby’s red blood count
B. What drugs the mother took in labor
C. If the mother is GBS positive if she was treated with
antibiotics
D. Baby’s fluid volume (feeding & stools) in the last 24 hours
E. If the mother’s membranes were ruptured and if so, for how
long
Do the attack skills work? Students say:
“Those attack skills you taught us, saved me. Sometimes when I do not
know an answer I can figure it out by highlighting and redoing the
question.”
“I used the those skills because I get nervous in exams and rush to find
the answer before I have read the question. Now this new way makes
me read the question.”
“Now it does not look like all these funny nursing school question are
all correct. The right answer pops out if I know the material.”
“I do not use the attack skills on every question. I do not need to. But I
circle the hard questions; then I go back and use the attack skills on
the really hard ones.”
“I don’t know if they work…but I am less panicked and my grade went
up 7 points between exam 1 and exam 2.”
NCLEX Pass Rates
2008
2009
2010
2011
2012
2013
2014
2015
Source: NC Board of Nursing, 2016
92.6
98.5
98.5
98.3
99.3
98.0
97.0
99.0
Two Case Studies
• 2 Non-Duke students that had failed NCLEX, multiple times
• Both from 4 year traditional BSN programs
• Both schools had good reputations
• Both schools used ATI
• Jason’s school used the end of course ATI exams but “did not put
much emphasis on the exams to the students” (or so he said?)….and
did not count ATI grade in the course grade. “We just blew them off.”
• Rhonda’s school saved up all the ATI exams + the predictor till the
last 3 weeks of the program and gave them ALL to the students over 3
days. *Rhonda did not know by the comprehensive predictor
she was “high risk” to fail NCLEX on the first attempt. No one
at her school explained what the scores meant to her success.
Rhonda
Failed NCLEX 3X. After the 2nd failure, thinking she would pass, she interviewed
for a job and accepted the job. She retested the 3 rd time and failed and was
devastated…but the hospital “held” her job, while she tried one more time to
pass.
Her father found me online through WyzAnt Tutoring and brought Rhonda to
me (driving 90 minutes to Durham, every Saturday). I was able to review her
ATI scores, as she still had access to her ATI transcript. It was clear by her
graduation she was predicted to fail. Her faculty did not tell her and she did
not know how to read the ATI transcript.
We worked together face-to-face weekly. Key to her success was building up
her self-confidence. She worked 5 days a week independently and had a daily
assignment and reporting to me from late August 2015, till the first of
November.
Rhonda passed on her fourth attempt, 2 days
before Thanksgiving 2015. She now is working.
Jason
Jason failed NCLEX 4X. He had a low ATI comprehensive predictor at graduation. He tested
quickly after graduation & failed. Thought it was a “fluke” and tested again, and failed.
Despondent and with a family crises, he let 9 months lapse.
He studied, retook NCLEX for 3rd time and failed then retook it 45 days later and failed the
fourth time, after studying on his own and taking an “online” course.
The day I met Jason I gave him a 10 question exam that I had developed. He scored 70%.
When we talked about the questions and his thinking, it became immediately apparent that
his thinking was very “circular.” When I questioned him about ADD…he confirmed that he had
been diagnosed, had learning issues since childhood and was on medication. He did not use
his medication for any of his NCLEX attempts. He did not have extended time for NCLEX.
We worked together weekly from late July 2015 -late October. In October, with my coaching,
he was able to negotiate through his school and ATI for him to take the virtual ATI course. He
worked with me + virtual ATI till December, then just virtual ATI till Feb. He got his medication
reevaluated and I coached him through the process of obtaining extended time for testing.
On his meds with extended time, he PASSED on February 15, 2016. He is on his second
interview for a job in adult health & excited to move out of his parents house!
Summary
At Duke we believe,
• NCLEX preparation begins the first week students enter our program.
• We value the powerful tool that ATI is and we count ATI test scores as
part of the course grade.
• We teach students how to use the ATI tools and esp. to REMEDIATE
both course exams and ATI exams.
• We track EACH student closely through the program, using multiple
tools to help students be successful.
• We know our first time NCLEX pass rate is one of the key decision
factors potential students use in choosing us.
• We believe our Study Skills course is important and is only one “tool in
our tool chest.”
• Key to our success is the synergy that occurs with the ABSN faculty,
program committee and curriculum committee. On most days…..
WE ARE ALL ON THE SAME PAGE
Thank-you for your time &
attention to making our
students stronger!
Helen