Research Basis for Exams

ROLE DELINEATION STUDY:  THE FOUNDATION FOR
CPAN® AND CAPA® EXAMINATION BLUEPRINTS

The CPAN and CAPA certification programs are each based on the results of a Role Delineation Study (RDS) or Study of Practice.  A summary of the results of the study, conducted from 1999-2000 is described here.  A complete and detailed article describing this study can be found in the June 2001 issue of JOPAN.  This study reconceptualized the model on which the CPAN and CAPA examination blueprints were based.

A more recent study conducted from 2005-2006, resulted in minor changes to the examination blueprints, however the conceptual framework for the examination programs did not change. 

Conceptual Framework Identified

With a continued commitment to meeting the legal and regulatory standards proscribed for certifying organizations, ABPANC convened a Think Tank in May 1998.  The charge was to look critically at the conceptual framework for the CPAN and CAPA examination programs, which historically has been based on the Nursing Process.  In thinking about an organizing framework for the certification programs and considering patient vulnerability and the phases of anesthesia as defined by ASPAN, the Think Tank kept coming back to the fundamental reason for certifying perianesthesia nurses – to meet patient needs!

After brainstorming what those needs might be, it became clear that they fell under four domains or headings.  Building on some of the concepts described in the Iowa Intervention Project Nursing Interventions Classification (NIC), the proposed conceptual framework centered on the following four domains of perianesthesia patient needs:  (1) Physiological Needs; (2) Behavioral and Cognitive Needs; (3) Safety Needs; and (4) Advocacy Needs.  Assumptions were made that all perianesthesia patients have these needs regardless of the setting in which they receive perianesthesia nursing care.  Needs also change based on the five phases of the anesthesia experience as defined by ASPAN.

Thus, the conceptual framework for the CPAN and CAPA certification programs evolved into a model driven by the needs of perianesthesia patients, regar4delsss of the setting in which they receive perianesthesia nursing care.  Identifying the specific knowledge base required of perianesthesia nurses in order to meet these patient needs was critical in order to meet the standards promulgated for certification programs.

The ABPANC Board of Directors approved, in concept, the patient needs model, at their September 1998 meeting.

The contract to conduct the RDS was awarded to Professional Examination Service (PES) and a “kick-off” meeting was held in August 1999.  An Advisory Team was formed to oversee the study process and to serve as content experts.  Following a year-long study, which employed several methods of data collection, the ABPANC Board of Directors approved changes to the CPAN and CAPA examination programs.

Major revisions to examination blueprints made

Beginning with the November, 2001 examinations, each blueprint is organized according to four domains (or categories) of patient needs:  Physiological Needs, Behavioral and Cognitive Needs, Safety Needs, and Advocacy Needs.  Perianesthesia nurses sitting for the CPAN and CAPA examinations are tested on the knowledge required to meet the patient needs listed under each domain.  Given the difference in the time spent meeting patient needs in the four domains, the percentage of exam content for each domain differs depending on whether the candidate takes the CPAN or CAPA examination.

IMPLICATIONS OF STUDY FINDINGS ON THE PERIANESTHESIA NURSING PROFESSION

ABPANC was very excited about completing the 1999-2000 study – the results of which contributed to the body of knowledge for the perianesthesia nursing specialty.  This was the first time that the needs of perianesthesia patients have been defined in such a way.  Traditional nursing practice is based on a model driven by the setting in which care is being delivered.  Now a complete picture of perianesthesia patients, regardless of the setting has been described.  Identifying patient needs more broadly than just physiological and behavioral/cognitive needs is key to seeing a holistic picture of perianesthesia patients.  In addition, the certified perianesthesia nurse’s critical role in providing for patient safety as well as serving as a patient advocate is now explicitly defined and valued and is a major public protection issue.

SUMMARY

Patients are no more vulnerable than when they are under the effects of anesthesia.  Nurses must be proactive in ensuring patient safety and serving as patient advocates.  ABPANC believes that certification of registered nurses caring for perianesthesia patients is a fundamental way of ensuring quality patient care delivery.  ABPANC believes that organizing certification programs around meeting patient needs is crucial if a program is to be credible and relevant.  As technology changes, so do patient needs.  As patient needs change, so does nursing practice.  It is key that a certifying organization, like ABPANC, maintains test blueprints that are based on current practice.  To that end, conducting a Study of Practice, or Role Delineation Study every five years, or more often if indicated, is critical.  In fact, the standards for ABNS accreditation require this.  ABPANC’s certification programs are accredited by ABNS.

The 1999-2000 study provided the opportunity for ABPANC to make very deliberate decisions about reorganizing the framework on which the CPAN and CAPA examination programs are built.  The 2005-2006 study served as a means of updating specific patient needs and related nursing knowledge, resulting in minor revisions to the percentages of questions asked in each domain.  The following tables reflect those changes.

For the CPAN and CAPA examinations administered from November 2001 through November 2006, the following blueprints were used. 

Beginning with the April 2007 administration, the CPAN/CAPA examinations are based on the following test blueprints.  The percentage of questions found in each patient needs domain has changed to the  following. 

CPAN® / CAPA® Test Blueprints

For a copy of the current CPAN/CAPA test blueprints, click here (pdf).