This article explores the American Nurses Credentialing Center (ANCCs) primary accreditation educational design process (EDP) criteria that corresponds with the Association for Nursing Professional Development (ANPD) Scope and Standards of Practice (Harper & Maloney, 2016). According to Dickerson and Graebe (2018, p. 4), “Use of the criteria and standards is recommended when planning any educational interventions because they provide a sequential process for analyzing professional practice gaps, determining learner educational needs, [and] ensuring content integrity.” Content is based on best available evidence, strategies to actively engage learners are utilized, a summative evaluation of results of educational activities in relation to closure of the identified professional practice gap is developed, and use of that evaluation data is used to guide future activities. This article provides knowledge for the nursing professional development (NPD) practitioner/nurse planner (NP) to identify the underlying educational need that validates and contributes to the identified practice gap per the ANCC primary accreditation criteria and the ANPD scopes and standards.
Understanding Underlying Educational Needs
As described in the January article of this Administrative Angles series (Dickerson & Graebe, 2018), the first step in the educational design is identification of the practice gap, which is the “distance between where things are now and where they could or should be” (Dickerson & Graebe, 2018). The second criterion in the ANCC educational design process (EDP2) is the identification of the appropriate educational need (knowledge, skill, and practice) that validates the established practice gap. The identification of the underlying educational need focuses on what is required to fill the distance between what is occurring and what should be occurring related to practice and patient outcomes.
In EDP2, the criterion requires the NP to determine what nurses and other members of the health care team do not know or do not know how to do or are not able to do (ANCC, 2015). Standard 2 in the ANPD scope and standards (Harper & Maloney, 2016), details the responsibilities of the NPD practitioner in analyzing data to determine the learners' educational needs. Both processes highlight the importance of carefully considering the actual educational need of a learner, or groups of learners, related to a recognized practice gap.
Strategical Analysis of the Underlying Educational Need
It is not uncommon for NPD practitioners or NPs to be presented with an educational request that already identifies a perceived educational need. The request in and of itself may seem appropriate, but it is the role of the NPD practitioner or NP to further analyze the request to clearly identify and articulate the underlying educational need in relationship to the identified practice gap. In fact, some experts suggest using the desired state, or outcome, as a starting point in identifying the underlying educational need, describing it as a backward-planning process (Moore, Green, & Gallis, 2009). Miller's conceptual framework (1990) introduced the idea that learning follows a clear path, beginning with knowledge, followed by competence and performance, and ending with action (Figure). This framework acknowledges the fact that for learning to translate into practice, all four elements must be present. When one element is missing (i.e., an educational gap is presented) the NPD practitioner or NP must take the appropriate steps to confirm the underlying need so teaching methods, engagement strategies, and ultimately outcomes can directly align to the type of learning that needs to take place. Conducting a strategical analysis based on Miller's (1990) conceptual framework allows the NPD practitioner or NP to connect the meaning and purpose behind planning an activity. This is operationalized by taking the gap and drilling down to find the root or cause of the problem for the learner. Is it that they know (knowledge), but they are unable to show how (skill) or unable to perform (do)? When we do this, we begin to generate the underlying educational need for the activity, and a composite of where the gap is occurring whether it is in knowledge, skill, or practice. NPs may find it beneficial to shift the concept of the traditional needs assessment to be more of a strategical analysis of the professional practice gap.
The following is an example of the strategic analysis to determine the underlying need for an educational activity utilizing Miller's (1990) conceptual framework. Data in the emergency department (ED) at one organization show an increase in patient falls over the past quarter. This rate was higher than that of other EDs in the health system. The current state was identified as an increase in patients falling in the ED. The desired state is to decrease the number of patient falls in the ED. As noted earlier, the practice gap is the difference between what is happening (current state) and the desired state (what should be happening). The nurse manager of the ED brought these data to the NPD practitioner or NP requesting a mandatory educational activity for all nursing staff on the appropriate use of fall precautions.
The NPD practitioner or NP decided to use the backward-planning approach to design an activity that would improve patient outcomes and reduce patient falls in the ED (desired state). The following steps were taken:
- A drill down to the root cause of the problem allowed for the underlying educational need to be developed. This needs assessment was completed by, assessments including an environmental scan, direct observation of practice, a literature review, an analysis of quality and safety data, anecdotal feedback, and a review of current policies.
- Strategic planning questions such as, “what need for an educational activity is there related to falls in the ED?” and “why does this problem exist?” were asked.
- It was found that the majority of patients falls were occurring in patients under the influence of drugs or alcohol. It was also identified that the falls precaution protocols were implemented appropriately. However, these patients were at higher risk for falling and placed in areas of the ED that were not in direct line of sight.
- Through analysis, the NPD practitioner or NP was able to identify a specific population of patients who were falling more often in the ED, as well as a lack of knowledge related to this population among the nursing staff. The NPD practitioner or NP then developed a knowledge-based program on the impact of drugs and alcohol on falls risk, including methods to decrease the risk. In addition to the education, the NPD practitioner or NP collaborated with the nurse manager on other potential policy and operational opportunities that could assist to decrease patient falls (i.e., use of chair alarms on the ED stretchers).
In this scenario, the initial request was focused on a perceived educational need of knowledge related to nurses not implementing falls precautions. Through observation and a strategic analysis of information, the NPD practitioner or NP was able to verify that the need was not knowledge related to the utilization of the falls precaution policy, but rather knowledge on how to decrease the risk of falling for patients with drug or alcohol impairment. By completing the backward-planning process, the NPD practitioner or NP was able to clearly identify the educational need and to confidently design an appropriate educational activity to close the identified gap.
ANCC Primary Accreditation Criteria Implications
In the EDP2, the NP identifies the underlying educational need (knowledge, skills, and practice) that contribute to the professional practice gap (EDP1) by conducting a needs assessment. The needs assessment is an analysis of the professional practice gap that is done after the professional practice gap is identified. The process description for the provider unit should detail the steps the NP takes to identify the underlying educational need. By answering the following questions, the provider unit can evidence these processes: Why is there a need for this educational activity? Why does the gap exist for the learner, and where does the gap exist? Is the gap in knowledge, skills, and practice? Or is the disconnect with a policy or standard that does not contribute to a professional practice gap? Where do I want learners to be at the conclusion of this activity? A finely developed needs assessment that identifies the underlying educational need for the learner will provide an opportunity for the NP to design educational activities that target the reason the gap exists.
- American Nurses Credentialing Center. (2015). ANCC primary accreditation provider application manual. Silver Spring, MD: Author.
- Dickerson, P.S. & Graebe, J. (2018). Analyzing gaps to design educational interventions. Journal for Continuing Education in Nursing, 49, 4–6.
- Harper, M. & Maloney, P. (2016). Nursing professional development: Scope and standards of practice. Chicago, IL: Association for Nursing Professional Development.
- Miller, G. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65, S63–S67. doi:10.1097/00001888-199009000-00045 [CrossRef]
- Moore, D.E., Green, J.S. & Gallis, H.A. (2009). Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. Journal of Continuing Education in the Health Professions, 29(1), 1–25. doi:10.1002/chp.20001 [CrossRef]