A significant category of issues and problems related to promoting competence pertains to the limitations or absence of a cohesive conceptual framework that supports learning and assessment methods focused on practice competencies. Typically, teachers in academic and practice settings use traditional course objectives, lectures, and evaluation methods that often are characterized as teacher-focused, subjective, and inconsistent. These historical practices obscure the development of a specific delineation of practice competencies to be attained and documented. The basic problems center on changing these traditional methods and implementing others that are more outcomes oriented and consistent with contemporary practice needs, and doing so from the foundation of a defensible and cohesive conceptual framework. The purpose of this article is to describe the importance of such a framework and the integration of essential concepts in developing and implementing competency outcomes, interactive learning strategies, and psychometrically-sound performance assessment methods. The COPA Model is explored in detail to illustrate the integration of these concepts into an effective framework that supports competency outcomes and assessment required for contemporary practice. It presents an example to stimulate adaptation and application to meet the goals of diverse academic and practice entities. Although this article describes application of the COPA Model in the academic setting, the principles and criteria presented are equally applicable for educators in the service setting.

assessment --- competence --- competency-based --- evaluation --- nursing education --- performance examinations --- testing concepts

Performance in nursing, both in service and education, has been an activity that evokes feelings of apprehension and fear of failure. The service area is mandated by Joint Commission to evaluate competency of clinicians for safe practice and schools of nursing have a similar mandate to graduate students that are safe clinicians. The transition of process evaluation to a competency-based assessment system in both service and education sectors is threatening to the stakeholders who are managers, staff, faculty, and students. This article explores the various dimensions of threats to stakeholders, the investment of the stakeholders, and strategies that can be used to protect the stakeholders’ investment.

Ethics --- interstate practice --- nursing --- regulation

Outcomes research needs to be conducted in countries beyond the USA if nursing classification is to move into visibility and acceptance in health care delivery around the world. Clinical outcomes that reflect nursing interventions have not been well documented. Recent socioeconomic changes in Taiwan have provided a unique opportunity to measure nursing-sensitive outcomes in nurse-managed nursing homes. The purpose of recently completed research conducted in eight selected nursing homes in Taiwan was to explore factors influencing two nursing-sensitive outcomes, namely, biopsychosocial functioning and patient satisfaction. Nursing-sensitive outcomes are defined as changes in health status upon which nursing care has had a direct influence. The researchers considered the impact of both individual patient factors and organizational factors on the care outcomes. Individual patient factors were found to be significantly more important than organizational factors in determining biopsychosocial function.