1. Differentiating Objectives and Outcomes
Andrea Lee-Riggins, DNP, APRN-CNS, CCNS, RN-BC, CCRN
Thank You! Pam Dickerson, PhD, RN-BC, FAAN for allowing me to use your ANPD July presentation.

2. Learning Objectives
By the end of this session, the learners will be able to:
1. Differentiate between objectives and outcomes.
2. Identify the S.M.A.R.T elements of an outcome statement.

3. Learning Outcome
By implementing the ANPD model and framework through the Fostering Excellence in Educators program, clinical nurse educators and clinical nurse specialists will value their role in providing high quality professional development offerings to clinical staff that support corporate-wide initiatives and unit-based identified needs that also, improves practice, performance, and care delivery by June 30, 2018.

4. Key Points ■ Outcomes reflect “end-game” expectations
■ Outcomes only make sense in the context of practice gaps, educational needs, and target audience
■ Outcomes provide measurable evidence of change from
“current state” to “desired state”
■ Outcomes support your value to your organization
■ There is no “magic list” of outcome measures
■ Objectives can be stepping stones or stair steps to help
achieve the outcome

5. Outcomes in Context
What?
Why?
So What?
How?
Are we there, yet?

6. The First Question: What?
■ What is the “professional practice gap”?
■ What is the driver or the reason for this activity?
■ What is the space between where the learner is now and where the learner should be?
Last month, Floyd described the purpose of a learning need, which is “any gap between needed and actual knowledge, skills, and behaviors, which can be remedied with an educational plan.”
A driver for the activity is the “future” state that we want or need to get to. For example, an organizational strategic goal is to implement the Caring Theory, or we need to improve documentation of pain management based on Joint Commission Standards.

7. Professional Practice Gap
Current State
Desired State

8. The Second Question: Why?
■ Why does this gap exist?
■ What evidence supports the professional practice gap?
■ What evidence suggests that there are other / better options?
The only way to answer the Why question is to make observation, do surveys, interviews, focus groups, etc. This will help you identify what the gap is and potentially a solution for solving the problem.
For example, at FHSH, we had been struggling with Heparin Nomograms. Nurses would say, it shouldn’t take 3 or 4 RNs to interpret a nomogram. Some tools (i.e. the Anticoagulation calculator) were recommended and embedded on the MAR. We showed the staff the tools in March 2015 and by November 2015, staff were saying the tools didn’t work. So, I knew I had to do some observations, so I observed a few RNs in CVU, and I realized the reason the tools didn’t work, was because we didn’t show them how to use the tools properly in EPIC.

9. The Third Question: So What?
■ How will this proposed education make things better?
■ When the gap has been closed, what will things look like?
■ How will the proposed educational activity contribute to closure of the gap?
■ How will I measure success?
Another way of thinking about the So What, is to try to figure out what the “future” state should look like when the gap is closed. For example, we still have a Heparin nomogram infusion gap at FHSH, however, Alexis in her role as a CNE, has been able to narrow the gap by educating our travelers and new hires. Our future state is to have RNs who can accurately calculate the Heparin dose based on the nomogram. Our specific educational activity is a simulation in the EMR training environment that incorporates the embedded tools in the EMR workflows.
Measuring success IS very important, because it will demonstrate our value in contributing to decreased hospital-acquired conditions, patient outcomes, and care delivery. You’ll need to develop metrics to monitor and evaluate progression towards the stated outcome based on the educational activities you plan, design, and/or develop.

10. The Fourth Question: How?
■ How do I develop the educational experience to help learners close the identified gap?
■ How do I actively engage learners?
■ How do I ensure that content integrity is maintained?
You’ll need to seek expert advice depending upon the topic or learning activity that may be needed. For example, I worked with one of our informatics nurses at FHSH to develop the Heparin simulation experience. Some of the nurses had requested a Heparin simulation, because quite frankly, they were getting frustrated, as well. We engaged the learners and ensured content integrity by developing a standardized script that could be used by the FHSH Education team. We engaged the learners with the script by guiding them through the workflow in the EMR training environment. We had to meet them at their level of utilization of the current embedded tools in order to demonstrate to them how the embedded tools worked.

11. The Fifth Question: Are we there, yet?
■ What evaluation data will demonstrate closure of the practice gap?
■ How do I collect and analyze data?
It will be different for each educational activity that is designed or developed. For example, the metrics I used to demonstrate success were: Heparin nomogram calculation accuracy, MAR Actions utilized, and PTT timing. I collected baseline date prior to and after implementing the educational plan.

12. Measurable Evidence of Change

13. What is an Outcome? ■ Webster: “A final consequence”, “result”
■ NPD Scope & Standards, 2016: “something that follows, is the result of, or is the consequence of a project, program, or event”
■ Outcome Measurement: “The process of observing, describing, and quantifying predefined indicators of outcomes of performance.”

14. What Do We Mean by “Measurable”?
■ Webster – Able to be measured; of distinguished
importance – SIGNIFICANT
■ Webster – “Measure” = basis of comparison
■ Quantifiable
EVIDENCE
■ Observable

15. Writing an Outcome Statement

16. Writing S.M.A.R.T. Outcomes
Specific – simply written and clearly defines what you’re going to do. This includes the: What, How, and Why
Measureable – tangible evidence that you have improved the outcome or achieved the goal.
Achievable/Attainable – the outcome or goal should stretch and slightly challenge us, but defined so that we can achieve them.
Results-focused/Relevant – it measures the outcome not the activity.
Time-bound – a timeframe that creates a practical sense of urgency, or results in tension between the “current” state and the “future” state.

17. Learning Outcome
By implementing the ANPD model and framework through the Fostering Excellence in Educators program, clinical nurse educators and clinical nurse specialists will value their role in providing high quality professional development offerings to clinical staff that support corporate-wide initiatives and unit-based identified needs that also, improves practice, performance, and care delivery by June 30th,
Specific:
What – By implementing the ANDP model and framework
How – Through the Fostering Excellence in Educator program
Why – CNSs and CNEs will value their role
Measureable: Yes, the metric is by June Will you value your roles in providing high quality professional development programs for staff?
Achievable: Yes, this is dependent upon the skill set we’re trying to attain. Through the FEE (Fostering Excellence in Educators) program, can we move you to assess how your role influences practice, performance, and care delivery, corporate-wide and at the unit level.
Results-focused – Yes, because it’s a process that will lead us to evaluate initiatives and learning needs that improves practice, performance, and care delivery.
Time-bound – June 30th provides the deadline.

18. Benefits of Outcomes Evaluations
■ Validate increased knowledge
■ Demonstrate skill performance
■ Confirm improved performance
■ Contribute to organizational goals
■ (Read: How to keep your job!)

19. Demonstrating OUR Value
■ Quality improvement
■ Cost savings
■ Recruitment and / or retention
■ Improved communication
■ Better decisions based on evidence
■ Others…

20. There’s NO “Magic List”
For outcome statements.

21. The Way We’ve Always Done It
Objective
Content
Time Frame
Speaker
Teaching Method
Identify 3 characteristics of an outcome
Specific
Measurable
Achievable
12 minutes Me
Lecture
Discuss the value of outcomes
Focus
Provide direction
Set expectations
40 minutes
Lecture/Discussion
Summary/Evaluation
8 minutes
Q&A
What’s wrong with this picture?
Where’s the learner?
Does it matter how you evaluate me at the end of this session, activity, or presentation?
Has the educational activity made a difference in practice?

22. Logic Model Input Output Outcome Gap Analysis Educational Plan
Gap reduced or eliminated
Learner needs assessment
Objectives and content
Target Audience
Teaching tools and references

23. NPD Practice Model, 2016

24. Objectives: The Means to An End: Setting Your GPS
Current location
Desired location
Route to get from point A to point B
Specificity helps!

25. The Means to an End Outcome Closing the Gap Practice Gap Objective 3

26. Key Points Outcomes reflect “end-game” expectations
Outcomes only make sense in the context of practice gaps,
educational needs, and target audience
Outcomes provide measurable evidence of change from
“current state” to “desired state”
Outcomes support your value to your organization
There is no “magic list” of outcome measures
Objectives can be stepping stones or stair steps to help achieve
the outcome for an activity

28. References
■ American Nurses Credentialing Center (2015) ANCC Primary Accreditation Provider Application Manual. Silver Spring, MD: Author.
■ Dickerson, P. (2015). How to write an outcome statement. Journal of Continuing Education in Nursing 46(9),
■ Harper, M. & Maloney, P. (2016). Nursing professional
development: Scope and Standards of Practice, 3rd ed. Chicago: Association for Nurses in Professional Development.