Educational Design

Q. What types of assessment methods are acceptable for identifying the learners’ needs?
A. Nursing continuing professional development (NCPD) activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Identifying problems in practice and opportunities for improvement may be elicited through a variety of methods, including, but not limited to:

• Written needs assessment or survey of stakeholders, target audience members, or subject matter experts
• Individual input from stakeholders such as learners, manager, or subject matter experts
• Content request by nursing management, based on internal quality measures or identified need
• Quality studies or performance improvement activities
• Evaluation data from previous educational activities
• Trends in literature, law and/or healthcare
• Trends in practice, treatment modalities and/or technology

Q. What types of supporting evidence can we use when planning an educational event? 
A. Supporting evidence or documentation is used to further validate the need for this educational activity.

Some examples from which evidence can come include, but are not limited to:

• Annual needs assessment or survey
• Review of the literature
• Requests from stakeholders
• Activity evaluation summary results
• Surveys from stakeholders or learners
• Outcome or Quality data (i.e., Regulatory)
• Research findings
• Directly from a content expert

Q. How is gap analysis conducted?
A. The process of gap analysis looks at the data collected during the assessment phase and determines where the target audience nurses are in regard to the problem versus where you want them to be. Gap analysis includes deciding which type of gap(s) exist – knowledge gaps, skills gaps or practice gaps. Once the type of gap is determined, learning outcomes can be developed to guide the educational activity toward narrowing or closing the identified gap(s).

Q. Are we required to complete a Gap Analysis Worksheet?
A. The use of the Gap Analysis Worksheet is required by the Midwest MSD., It is a way to relate the current state of the target audience, organize the problem in practice, the desired state and the type of gap revealed. An agency may also provide gap analysis data as part of their determination of a professional practice gap.

Q. How is gap analysis linked to Learning Outcomes?
A. Once the planning committee has determined what gap(s) is present, learning outcomes must be developed to determine whether the educational activity can help to narrow or close the gap. For instance, if gap analysis has determined that nurses on a particular unit lack knowledge in patient fall prevention, a learning outcome of “Learners will self-report an increase in knowledge of how to prevent patient falls” will determine whether the activity adequately addressed the identified gap. An additional or alternative long-term learning outcome might be “Reports of patient falls on Unit X will decrease by at least 20% in the 90 days following the activity”.

Q. What are the best practices for writing learning outcomes for a NCPD activity?
A. The ANCC has moved from learning objectives (developed by presenters and describing what planners hope will happen) to learning outcomes (developed by planners and describing what will be measured during or after the activity) in order to provide activity planners with meaningful data that can be used to improve an existing activity or enhance the planning process for future activities, as well as impact patient outcomes. In addition, the use of learning outcomes and outcome measures provides evidence showing the activity was successful at narrowing or closing the identified gap(s). One of the key responsibilities of the planning committee is to write appropriate learning outcomes for the educational activity that will address the identified gap(s) and provide measurable data of the results of the activity. Outcomes can also serve to direct what teaching/learning strategies to utilize, to estimate time frames, determine learner engagement strategies, and evaluate the activity.

Best practices include:

• Outcomes must be measurable and focused on what the learner should do or have during or as a result of the educational activity.
• Outcomes should contain only a single action verb that defines the expected behavioral outcome. Note that the participant will actually DO the action of the verb, not just rate it.
• Outcomes are planner/presenter tools. They are normally not communicated to learners like objectives were.
• Outcomes may be generalized and apply to an activity in its entirety (often utilized for multi-day, multi-session and/or multi-topic offerings) or specific to key learning (often utilized for single-topic activities).
• Unlike objectives, not all content sections need to be ‘covered’ by learning outcomes. Planners should select key take-aways that, when measured, will indicate that the identified gaps have been narrowed or closed.

Q. We are planning a large conference with multiple presentations. Does each session require its own learning outcome(s)?
A. Two options are available to planners when developing learning outcomes for multi-session activities:

• 1 or 2 overarching learning outcomes that describe the key take-aways for participants from a global perspective
• 1 learning outcome for each session that is specific to that session’s content

Q. My presenter sent a list of objectives on their Educational Planning Form, even though we provided him with our learning outcome. What should we do with those objectives?
A. As long as the presenter also provided the required content outline, the planning committee may disregard the objectives. Many presenters are so used to developing their content around objectives that many will likely continue to use them as a way to organize their thoughts and materials.

You can make it part of your communication with presenters to inform them that objectives are no longer a part of nursing continuing professional development, although they are free to utilize them if they find it helpful. You might have to specifically state that objectives should not be submitted or utilized on PowerPoint slides during the presentation.

Q. Are there specific criteria for developing a title of a NCPD activity? 
A. While there are not specific criteria regarding titles of NCPD activities, there are best practices to consider:

• State Boards of Nursing and other certifying and re-certifying bodies such as ANCC when auditing a nurse’s records look to verify that an educational activity was worthy of nursing contact hours. That can often be determined by the title if it accurately reflects the content of the activity.
• NCPD activities should be planned to enhance the nurses’ professional competence, learn about new treatment regimens, update clinical skills and go beyond the entry level of education; therefore, terms such as “basic”, “introduction”, “fundamentals”, “101”, and “review” should be avoided in titles.
• The title should have meaning to the target audience – not just the planning committee; therefore, it is best to avoid “cutsie” wording, slang, abbreviations, and other terms that are not easily understood.

Q. What is required to be included in the evaluation of an educational activity? 
A. It is important to remember that evaluation of an educational activity may take place in a variety of formats. A return skill demonstration, electronic polling, a pre or post-test, a case study analysis, role play or active participation in an educational activity are examples. When an evaluation form or survey is provided to learners, best practices indicate that the following should minimally be included:

• Were the learning outcomes met? When measured on the evaluation tool, it is recommended that a variety of question formats be used (yes/no/if no, why not, Likert ratings, open-ended) in order to stimulate thoughtful responses and provide planners with meaningful data.
• If overarching learning outcomes were utilized, the evaluation questions should drill down to the key take-aways determined by the planners for each individual session or activity.
• Did the presenters have expertise in the content they discussed?
• Was there evidence of bias?
• How will the participants integrate what they have learned into their current practice? What barriers do they perceive to successful integration?

An evaluation form is required as one method for Individual Education Activity applicants.

Q. For our learning outcome, why can’t our evaluation ask participants any more to rate their ability to do something, like “List the priority of treatment for patients with hemorrhagic stroke”. Isn’t that the same as self-reporting?
A. The key lies in the wording of the learning outcome. If your outcome states, “Learners will list the priority of treatment for patients with hemorrhagic stroke” and the evaluation question says, “Rate your ability to list the priority of treatment…”, the planners have not measured whether the participants can actually list that priority of treatment – participants are just telling you whether they think they can. This is no different from objectives. In order to measure whether a learner is able to list the priority of treatment, you must have each learner actually do so, whether it’s in a small group exercise during the activity, or in a neighbor-graded posttest at the end of the activity, or as an open-ended question on the evaluation tool.

If the planners determine that self-reporting of an increase in knowledge or skill is sufficient to close the identified gap, then the outcome should begin with “Learners will self-report an increase in knowledge on….”

Self-report measures are less reliable than measures that require participants to do some action during the activity itself or immediately afterward. It is best practice to include both types of learning outcomes whenever possible, so that the measured data elicited is of the best quality and reliability.

Q. What are the requirements for electronic signatures (on disclosure statements, financial relationship reporting statements, etc.)?
A. Physical, original signatures are not required. However, if a physical signature is not used, then documentation that you received the disclosure information from the source of the information will be needed. For example, if the form was faxed, you would need to save the cover sheet with the person’s name and phone number on it. You need to use a method that makes you comfortable that documentation has been secured, and which provides verifiable proof after the fact. It is the Nurse Planner’s responsibility of ensuring that the electronic signatures are valid and reliable.  It is acceptable to use a single form to meet the requirements of multiple accrediting bodies. The individual requirements for each accrediting body must be met by the form. It is also important that the signature be appropriately dated by the signee.

What is acceptable?

• Original and legible physical signatures on a document
• Electronic print of an actual physical signature on a document
• A signed document that is scanned and then electronically submitted
• Documents that are signed and then faxed
• A document with a specific check box to indicate the individual has “signed” in agreement.  The Nurse Planner must be able to substantiate that this is valid.

Q. Do poster presentations need to be planned as an educational activity? 
A. Poster presentations are beneficial to disseminate information on current trends in research, practice, leadership, and education. They provide a unique opportunity to engage nurses in conversations directed toward a specific topic. If the intention is to award nursing contact hours for the viewing of the poster presentations, then the educational design criteria apply as they would for any other educational activity or session. Posters authored by students in pre-licensure nursing programs, even if mentored or monitored by an RN instructor, are not eligible for contact hours, as these students do not have the experience or expertise to qualify as presenters of NCPD. Posters developed by graduate-level nursing students (but not pre-licensed nursing students) under the supervision of nursing faculty may be considered for inclusion. The target audience must be registered nurses. Minimally, a planning committee should require completed and signed Biographical Data and Financial Relationship Reporting Forms from individuals presenting posters (authors) as well as those reviewing poster abstracts for inclusion for posters that address clinical topics. In this way, appropriate disclosures regarding conflicts of interest can be shared with learners. The Provider would need to develop learning outcomes for the time spent viewing posters and determine an appropriate evaluation method. The provider must also have a means of validating that an individual met the requirements of successful completion associated with poster viewing.

Q. Can contact hours be awarded for poster presentations? 
A.The ANCC/Midwest MSD Accreditation Program is not prescriptive in dictating the logical and defensible method that must be used, therefore Individual Education Activity and Approved Providers have flexibility in determining what method works best for the particular setting or circumstances of the activity. Here are some suggested methods that may be considered regarding awarding contact hours:

• Pilot test the number of posters that can be reviewed during a time period and award contact hours based on the pilot test data. Participants attest to the time they spent reviewing the posters using an attestation form. Regularly evaluate the pilot test data to validate accuracy.
• Require participants to review and complete an evaluation form for the poster session. The Provider may choose to require an evaluation form for each poster reviewed or for the full poster session. Pilot test the time required to review each poster or full poster session and award contact hours accordingly. Regularly evaluate pilot test data to validate accuracy.
• Hold the poster presentation session over a set period of time and log participants into and out of the session. Award contact hours based on the set period of time.
• Require participants to review each poster and/or a set number of posters and complete a post-test. Successful completion based on passing the post-test. Pilot test amount of time required to review posters and complete post-test. Regularly evaluate pilot test data to validate accuracy.
• Provide a means for participants to attest to the time spent in poster viewing and the information learned.

Q. Can content previously developed be incorporated into an educational activity? 
A. Content previously developed may be incorporated into educational activities for continuing nursing education credit within the following guidelines: The Nurse Planner and planning committee must:

• Conduct an independent needs assessment and gap analysis specific to their target audience
• Identify previously developed educational content that meets the learning needs of the target audience
• Develop new learning outcomes independent of any prior objectives or outcomes for the content.
• Possess evidence the previously developed content is current, evidence-based, meets current standards or practice guidelines.
• Provide evidence of revisions/deletions/additions required for the previously developed content OR evidence stating why previously developed content did not require any revisions/deletions/additions.
• Ensure the previously developed content is objective and unbiased; and excludes any promotional influence.
• Verify that the previously developed content meets the definition of “continuing education” as described by the American Nurses Credentialing Center’s Accreditation Program.
• Ensure that new learning outcomes are appropriately measured on evaluation tools.

The Nurse Planner and planning committee may not approve a previously developed educational activity and award nursing contact hours without complying with these guidelines. Failure to adhere to these guidelines may result in loss of approval status.

Q. If we want to provide a live presentation, and tape it for viewing by those who could not attend, what are the requirements?
A.In this situation, you will need to develop two separate activities – one for the live version, and one for the enduring version. Many elements of educational design apply to both versions, but some of the documentation requirements are different, which is the reason why two activity files are needed.

The enduring material version will need additional planning, since it will be necessary to develop a way to ensure that learners did actually view the material and absorb the material presented. The most common way to ensure this is by developing a posttest over the key take-aways identified, although other methods are possible. For most enduring material activities that are based on a live version, the enduring version will provide additional contact hours to cover the time for completion of the posttest.

Q. Do expiration dates only apply to enduring materials?
A.Yes. The expiration date must be visible to the learner prior to the start of the educational content. The period of expiration of enduring material should be based on the content of the material but cannot exceed 3 years (2 years for individual education activity applicants). The expiration date starts from the date the enduring material is first released.

Q. Do enduring materials have to be reviewed at any time? 
A. Yes, the ANCC/Midwest MSD requires the review of enduring materials at least once every 3 years (2 years for individual education activity applicants), or more frequently if indicated by new developments in the field specific to the enduring material. For Approved Providers, review of enduring material for accuracy and current information, a new expiration date is established. For Individual Education Activities, the provider must complete a new application to the Midwest MSD after review of materials.

Q. Planning documents ask for a “Full agenda/schedule for the entire educational event”. What is required?
A. A full agenda from registration to closing, including breaks for either an in-person event or a virtual event must be included in the educational activity planning file. The agenda must include a breakdown of contact hour calculations for all sessions awarding nursing contact hours. The full agenda/schedule will be compared to the timeframes listed on the Educational Planning Form to verify calculation of contact hours. Ensure that the contact hour award is consistent across all documentation. No agenda/schedule is required for activities of one hour or less.

This working agenda is different from what you may share with participants. In some cases, the full agenda/schedule will list more sessions than those for which nursing contact hours may be awarded. Be clear on the full agenda/schedule or other documents which educational sessions/ presentations will award nursing contact hours. It should also be clear to participants prior to or at the program which educational sessions/presentations will award nursing contact hours.

Q. How is a journal- based CE activity defined?
A. A journal NCPD activity is an activity that is planned and presented by an Approved Provider Unit and in which the learner reads one or more articles (or adapted formats for special needs) from a peer-reviewed professional journal.

When reporting journal-based activities in NARS, the APU may choose to report journal-based NCPD activities as a single activity per journal or as individual articles. For credits available, specify the amount of time required to complete the activity. The number of learners should equal the total number of individuals who completed the activity.

For example, a provider produces a journal that contains an article that is associated with an activity. Twenty learners read the article, reflect on the content, and complete questions related to the content of the article. The learners spend 1 hour on this activity. In NARS, the provider would report this as a journal-based activity with 20 learners, and 1 contact hour.

Q. If a live activity is turned into an enduring material, do faculty disclosure and acknowledgement of commercial support still need to be made?

A. Yes. The new NCPD activity, must demonstrate compliance with all applicable ANCC/Midwest MSD requirements, including the disclosure of relevant financial relationships to learners based on the financial information applicable at the time an individual last had control of content, and acknowledgement of any commercial support.  This is true even if the commercial support was only for the original live activity.

Q. If we planned an in-person, multi-day activity that is switching to a virtual format, would it now be considered a regularly scheduled series (RSS)?
A. RSSs are most often used by hospitals and health systems for repeated, ongoing educational sessions that are conducted by and for the organization’s staff. In general, if you are changing a single live, in-person NCPD course to a live, virtual format, that activity should be categorized instead as an Internet live course, rather than an RSS.

Q. If we record our regularly scheduled series (RSS) so that learners who miss a session can participate by watching the recording, do we report the live RSS in NARS as a single activity and then each of the recorded sessions as separate enduring materials?
A. A regularly scheduled series (RSS) is a live activity that generally targets the same learners over the whole series. If you choose to record some or all of the sessions and make the recordings available to the learners who would normally participate in the live sessions, those recorded sessions are still part of the RSS and do not need to be reported in NARS as separate enduring materials. You would report the RSS as a single activity in NARS.

If you decide to make some or all of the recorded sessions available to a different audience (not the learners who normally participate in the live sessions), either as individual sessions or as a series, this new activity should be reported in NARS as a separate enduring material (or multiple enduring materials).