A competency-based approach to the nursing research

Introduction 

This paper describes the use of a competency-based approach to the study of nursing research with a group of second-degree students engaged in a university based accelerated program of study in the United States of America (US). The second-degree student is one of the fasted growing populations in nursing education today. The accelerated second-degree BSN program is a curricular innovation to enroll more students in nursing programs and to meet work-force needs. Students who seek accelerated second-degree BSN programs are informed and critical consumers of the educational experience. They choose an accelerated program, because it is an efficient way to change careers. They are described as being more mature, diverse and self-directed learners (Cangelosi and Whitt, 2005). As new programs of study for non-traditional student populations are introduced, it is critical that we do not simply re-organize the existing courses into a compressed format and continue with the same pedagogical methods and teaching strategies. We need to recognize and acknowledge the gifts of these non-traditional students and to adapt new strategies to meet the needs of this student population.

A review of the academic histories of our accelerated students revealed that they all had a research methods course in the curriculum of their first degree program of study. The curriculum of our accelerated second-degree program has nursing research offered as an on-line course, in the last semester of the program. The use of an on-line platform for course delivery is essential in our curriculum due to the intensity and number of credit hours per semester. The asynchronous nature of an on-line learning experience, respect for the student’s prior learning and transference of knowledge between disciplines of study makes a competency-based approach optimal for this student population and course content. A competency-based approach also provides the students with an experience that prepares them to meet the needs of patients with complex needs in a rapidly changing healthcare environment (Candela et al., 2006).

The mission of our accelerated nursing program is to prepare nurses for practice, yet the nursing research course is often viewed by students as disconnected from the real world of nursing practice. The current focus on the evidence base of nursing makes research application an essential skill for entry into practice. Previous studies have investigated the perception of nurse educators, nursing students and practicing nurses about the theory-practice gap (Shuster et al., 2007, Corlett, 2000). According to Tilley (2007) competency-based education is essential for bridging the gap between education and practice and includes increasing the level of competency, learner accountability, self-assessment and individualized learning experiences. A competency-based approach is a strategy that acknowledges the second-degree student’s prior learning as a platform for the study of nursing and to make the linkage between research and nursing practice clear and useful to the student. Professional programs enjoy a natural connection with competency-based education, because of the clear relationship between student performance and work-force expectations (Oermann, 2004).

Traditional pedagogies emphasize learning facts and a student’s thinking is evidenced by their ability to memorize and recall content knowledge and it is assumed that memorized content can be used in nursing situations (Ironside, 2005). Consequently, educators focus their energy on covering course content and not on developing the thinking and judgment skills needed to apply knowledge to a nursing practice situation (Tanner, 2001). Interest in the outcomes of higher education have been intensified as many states now have accountability schemes in place that examine institutional success in achieving student competence (US Department of Education, National Center for Education Statistics, 2002). These external agencies seek to measure outcomes of the educational process at a level that requires precise description and measurement of student learning. Similarly, Voorhees (2001a) described a revolution that is occurring in which the labor market is progressively holding post-secondary institutions accountable for demonstrating that students have learned the competencies needed in the work place. As educators we have a professional responsibility to not only facilitate learning about research in our discipline but to prepare graduates who can evaluate and use research findings in the practice setting.

Literature review 

The introduction of a competency-based approach for the learning of nursing research fulfills both knowledge and professional socialization needs of the accelerated second-degree learner. Accelerated students have a desire to learn how to manage real-life situations and view education as a way to become more competent and to achieve their full potential (Smith, 2002, Raines, 2006). Second-degree student have academic ability and key skills that can be transferred to the study of nursing. Experience shows that second-degree students demonstrate the ability to learn complex material quickly and thrive on application learning in place of structured memorization in artificial environments. Congruent with the characteristics of adult learners accelerated students want to know that what they are asked to do is supportive of their learning. They are extremely intolerant of busy work and fluff courses and they ask “why” questions and challenge faculty and peers (Cangelosi and Whitt 2005). A competency-based approach emphasizes outcomes and the application of knowledge determines the value of the educational intervention (Arbour, 2003).

The literature identifies that those teaching strategies which work with the traditional student, may not be equally effective for students in an accelerated program (Oermann, 2004). Teaching styles and interactions with these students need to match the characteristics of the student and the experiences they bring to the study of nursing. The terminology, principles and methods of research share many commonalities across discipline of study. Research is often seen as the domain of nurse scholars and theorists. However, research application is vital to patient well-being and the definition of nursing as a unique discipline. A competency-based approach to the study of nursing research encourages the student to be active in making the linkage between practice and research.

The traditional approach in nursing education based on a behavioral pedagogy is faculty directed delivery of a curriculum that is fixed and linear. Learning is passive; topic centered and emphasizes the accumulation of knowledge by the student. The outcome or measure of learning is usually a grade based on recall of what the teacher wants the student to know (Peters, 2005). The learner often does not have the opportunity to demonstrate application of knowledge. In general, the traditional approach results in learning that is temporary, short-lived and contained within the boundaries of the course.

A behavioral approach ignores the connection between knowledge, skills, intention to act, context of the performance and the effects of interpersonal aspects of achievement. In addition, a behavioral approach ignores a large body of research which suggests that competences are not value free, but are applied within the social constructions and cultural practices of the situation (Harris et al., 1995, Romyn, 2000). Barrie and Pace (1997) point out that the measurement techniques associated with the behavioralist model of learning are problematic as indicators of significant learning. This approach in which learning is achieved/not achieved is simplistic and de-motivating and promotes a minimal level of acceptable performance rather than a standard of excellence.

Competency-based education is an individualized teaching–learning process which emphasizes flexible ways of achieving knowledge and performance outcomes (Arbour, 2003). It takes the process of learning and the outcomes of the learning activities beyond the boundaries of the course and the classroom and into the real world of nursing practice. Tanner (2001) defined competency-based education as that which emphasizes individual learning processes and flexible ways of achieving knowledge and performance outcomes.

A competency-based approach is learner centered. It emphasizes that learners are active, goal directed, self actualized problem solvers with accumulated life experience that influences what is learned. The National Post-Secondary Education Cooperative defines competency as the blend of skills, abilities and knowledge needed to perform a specific outcome (US Department of Education, National Center for Education Statistics, 2002). In a study with dental students, Yip and Smales (2000) found a competency-based approach reduced passive learning and dependence on teachers and promoted active student centered learning and critical self appraisal. A competency-based approach transforms the relationship between teachers and students as competency is evaluated through demonstration and performance. The student’s knowledge needs drive the learning process. The faculty role is to design quality learning activities, track progress towards competency attainment, encourage excellence and validate competency achievement. In Voorhees (2001b) study, students graduating from a competency-based learning program felt more competent than those from a traditional curriculum.

A competency-based approach focuses on knowledge application rather than knowledge acquisition. Competency-based outcomes look at a level of knowledge needed to demonstrate competence and not just the time spent in the classroom (Sanson-Fisher et al., 2005). The connection between knowledge and competency is a product and the performance is the outcomes needed by the workforce.

Competency-based approach to nursing research 

The teaching of nursing research is frequently general and a contextual. Our decision to use a competency-based approach for the teaching of nursing research was based on what is known about the accelerated second-degree student population and the objective of our accelerated nursing program. The goal was to move beyond knowledge acquisition to intentional application to nursing through the active construction of meaning in authentic and real world environments (Raines, 2006).

True competency-based approaches are not limited by the boundaries of time (Tilley, 2007). Given that we are within a traditional university setting, the course is offered within the usually 15 week semester. Yet, the use of the on-line learning platform facilitates the individualization of learning activities to student’s learning pace and interests. Table 1 illustrates the application of characteristics of a competency-based approach and how they were enacted in this course. The competencies in this course are sequenced and there are end dates for the achievement of each competence to assure students have the opportunity to meet all competencies within the standard semester. Students have the opportunity to work ahead, but there are built-in safety nets to rescue the stragglers. The mapping of competencies with Bloom’s taxonomy shows the increased level of complexity as the student progresses from knowing to using/applying knowledge to practice (Bloom and Krathwohl, 1984). The learning activities parallel the process of developing evidence-based nursing practice guidelines as described in the literature (Salcido, 2002, Oxman et al., 2006, Schmidt and Brown, 2007).

Table 1. Characteristic of competency-based approach applied to a nursing research course

	Characteristic of competency-based approach	Application of characteristics to the nursing research course
	Competencies are carefully designed Essential knowledge and theory is learned and integrated within the context of the practice of nursing	Competency statements: •Validates knowledge of research terminology, concepts, methods, and practices •Identifies a nursing practice and searches a variety of databases for evidence •Demonstrates skill as a critical consumer of nursing research •Demonstrates ability to describe the evidence-based of the selected nursing practice •Presents the evidence base of a nursing practice to a group of practicing nurses
	Learning activities are focused on the competencies to be achieved and support the acquisition of knowledge and skill Learning activities are designed to meet differing learning styles and are individualized to the learner A variety of learning activities are available for the student, to provide the option of learner selected participation in learning	Learning activities include: •Research textbook and selected readings •On-going asynchronous discussion boards to explore and clarify research-specific knowledge •PowerPoint presentations, teacher guided interactive lectures and self-assessment activities to provide the learner a means of gauging readiness for fulfilling competency •Gaming and on-line simulations to facilitate critical thinking and knowledge integration •Links to external sites describing the use of research in practice and evidence-based practice. •Detailed rubrics are provide for each competency •Use of ANA Guidelines for the development of evidence-based practice guidelines and PICO model •Examples of completed evidence-based projects to support nursing practice are posted •Individual meetings with faculty for mentoring and guidance in selection of learning activities •Peer-to-peer discussion areas for sharing of the literature, ideas and mutual support
	Faculty guided learning supports mastery and the premise that all participants can achieve competency Learning is flexible and self-paced	•Competencies are sequential. Learners can work ahead, but getting behind is not an option •Individual meetings (Mentoring sessions) between faculty and learner are held every other week. Meetings occur in the faculty’s on-line private office/chat room and are focused on a review of the student’s learning and status of competency achievement •Faculty is available to identify additional learning resources and to collaborate with learners about readiness to demonstrate competency
	Prior knowledge and skill are assessed at the beginning of the learning encounter and those with satisfactory knowledge and skill move directly to competency demonstration	•Students complete an objective test on research knowledge during the first week of the course. Students who achieve a score of 90% or greater, have fulfilled the first competency and move directly to the competency focus on being a consumer of nursing research
	Completion of the course is based on achievement of all the specified competencies	•Completion of the competencies is validated by achievement of minimum scores on the rubric accompanying each competency

Faculty role 

While the competency-based approach is student centered, the faculty member cannot be absent. The role of the faculty, in our approach, is to guide the path to understanding and knowing by creating opportunities and incentives to build the knowledge necessary to demonstrate the learning outcomes and achieve each course competency. For each competency there are faculty guided on-line lectures and threaded discussions focused on the concepts and knowledge necessary to achieve the stated learning outcome. In addition the faculty models the significance of the evaluation and application of research-based knowledge within the context of nursing situations.

The faculty maintains a daily presence in the on-line course site to facilitate the posted learning activities and to motivate students to higher levels of analysis and understanding. This involves providing direct feed-back and critique of student work as well as asking probing questions to prod students to a higher level of performance and achievement. Because the student determines the pace of their individual learning, many learning activities are occurring simultaneously. A database embedded into the course gradebook facilitates easy tracking of student progress and completion of activities.

To guide the student on their individual learning journey, a faculty initiated one-to-one mentoring session is an integral part of the course design. Faculty-student mentoring sessions are scheduled every other week and occur in the faculty’s on-line private office/chatroom. The focus of the first mentoring session is to review the student’s performance on the knowledge assessment test and to map the student’s individual journey towards competency attainment and success. These individual mentoring sessions continue throughout the duration of the course. In these sessions the student reflects on their learning and the faculty provides guidance towards learning activities critical to achieving the learning outcomes. These mentoring sessions were scheduled for a consistent day and time. Mentoring sessions were planned to be 30min in length, but the actually time per session varied from meeting to meeting depending on the needs of the individual student and where they were in the process of demonstrating the learning outcome. Finally, because the achievement of competencies in this course is sequential and each competency builds on the ones preceding it, prompt feed-back and evaluation of student’s work, using the designated rubric is essential.

Student learning activities and outcomes 

The competency-based approach used in this course is characterized by the fact that learning outcomes were designed to be more or less representative of later professional activities. A key to evaluation in a competency-based approach is that the expected performance level must be clearly defined. All course activities are focused and progressively linked to enable and empower the student in the achievement of the course competencies. The defined and measurable competencies provide the learner with a conceptual map and the navigational tools needed to move towards their goals. Development of competency statements is the first step in the design of the course and guides the creation of learning activities and outcomes (Table 2). The entire course including the competencies, evaluation rubrics, learning activities and resources are placed on the on-line learning platform prior to the beginning of the semester, to allow the student to learn at their individual pace.

Table 2. Competencies, cognitive domains and learning outcomes

	Competency	Cognitive domain	Learning outcomea
	Demonstrate knowledge of basic research terms, processes and methods	Knowledge	Achieve a score of 90% on an objective test of knowledge
	Selects a nursing practice as the topic of a search for evidence-based nursing knowledge	Comprehension	Explains a nursing practice and the rational for choosing that practice as the focus of evidence-based practice guideline
	Conducts a literature search specific to the selected nursing practice	Comprehension/application	Prepare a literature search, from the discipline of nursing focused on the selected practice
	Writes a critical synthesis of the collected the literature	Comprehension/application	Prepare a critical synthesis of the collected the literature
	Develops an evidence table based on the literature	Application	Construct an evidence table from the collected the literature
	Develops an evidence-based guideline for the selected nursing practice	Application/synthesis	Create an evidence-based guideline for the selected nursing practice
	Presents the evidence-based nursing practice to a group of professional nurses	Application/synthesis	Design and present the created evidence-based guideline to a group of nurses

a Each learning outcome has a rubric describing the criteria for outstanding, excellent, very good, good, satisfactory and unsatisfactory performance.

Competency #2 

This competency bridges the domains of knowledge and comprehension. Students are directed to scrutinize the practice of nursing and to identify and describe a nursing practice that they perceive to be time-consuming, illogical or traditional. The identified practice becomes the focus of their work for the remainder of the course. Students are asked to differentiate the aspects of the nurse’s activities that are unique to the practice of nursing versus those activities that are technical skills or dependent role behaviors. This competency is the bridge into the real world of nursing practice, since the student selects a practice they have observed or enacted during their practice-based course work. Learning activities unique to this competency include structured interviews with nurses focused on the evidence-base of nursing practice, focused reading on evidenced-based practice and visits to professional organizations web-site and databases to review their evidence-based practice activities. Selected examples of the practices identified are listed in Table 3.

Table 3. Nursing practices identified as the focus of the application of nursing research skills

	Nursing practices identified by students (selected examples)
	•Waking up patient for routine procedures •Collection of mandatory lab specimens for all patients regardless of individual situation •Placement of ECG leads •Family presence during procedures •Use of “chux” or disposable pads on bed •Use of kardex and report rituals for communicating changes in patient status •Sharing of equipment: BP machines and thermometers that are moved from room to room •Taping technique for peripheral IV in the elderly •Turning of patients every 2-h •Shared rooms in the acute care hospital •Using Trendellenberg position in the treatment of hypotension

The experience 

The competency-based approach was initiated with a group of 40 accelerated second-degree students. During the pre-registration process, many student questioned the need to take a nursing research course, given that they had a research course on their transcript and in some cases had completed research focused graduate degrees or had held positions, involving the conduct of research.

Initially, the experience was unsettling as students adjusted to a course without specific teacher mandated assignments and in which the student had the opportunity to determine the pace and quality of their learning. This learner centric focus was unfamiliar and unsettling even for a group of students who are often identified as self-directed and desiring control of their learning experience. The engagement with the faculty during the initial one-to-one mentoring session and the establishment of a plan for moving forward, addressed most of the student’s individual concerns and anxieties. In fact, after the mentoring session, many students even expressed some excitement at the opportunity to explore and potentially impact a practice they perceived was illogical or out-dated.

Previous completion of a research course as part of their first bachelor’s degree was one of the guiding forces in the adoption of a competency-based approach to this course. However, only eight (20%) of the students were able to demonstrate knowledge level competence on an objective test of research terminology, methods and procedures. Majority of students scored in the range of 70–90% and three individuals scored less than 70%. This indicates that a solid knowledge base can not be assumed simple because the course appears on the transcript. During the mentoring sessions, many students shared that they tried the examination with no advanced preparation and admitted that their results were consistent with the lack of preparation. Using the provided learning activities and faculty guidance, all students were able to meet the minimum score on the objective test within the first couple of weeks of the course.

Students enjoyed scrutinizing the practices they observed and participated in at the clinical facilities. The descriptions of nursing practice and perception of the practice they choose generated lively and spirited on-line discussion. This also created a wonderful opportunity for the student and unit-based nurses to dialogue and think about nursing care and practices, beyond the completion of tasks. Students participated in a high level of collaborative learning and sharing of resources and strategies. Finally, the opportunity to present their work at the clinical facility was an experience that generated positive comments from students and unit-based staff. This experience provided the opportunity for the students to apply their knowledge to the clinical practice of nursing, and an opportunity to explore the evidence-base of nursing practice to the unit-based staff.

Overall the experience was highly successful. All students were able to achieve the competencies, many at a very high level of excellence. A few students had difficulty with the self-paced nature of the learning experience and had a tendency to lag behind. The time-to-task mutual goals setting between the faculty and student during the mentoring sessions, combined with individualized faculty attention to the student, culminated in their success. In the end student evaluation of the course was highly positive and comments included an appreciation of the opportunity to “really make a difference”, “produce a paper that was useful to my career goals” and “finally take a research course that makes sense and shows how important it is to practice”.

Whether, we like it or not the way we educate from preschool through postgraduate work has to change (Cooper, 2006). Nursing is not immune from this shift. Higher education and nursing education in particular has witnessed our classrooms move from the brick and mortar campus to the asynchronous and flexible on-line platform, and our student population has transformed from the traditional college student to the non-traditional student who presents with work and family responsibilities and life experience. As educators we have a responsibility to be responsive to these changes and to modify our teaching strategies to best prepare our graduates for the demands of the work-force. Use of a competency base approach to the study of nursing research is one such innovation. It is consistent with the needs of the second-degree student population. The focus on learning outcomes and the grounding of the course in the real world of nursing practice results in a win/win situation for the student, the practice setting, the faculty and college and the future employer.