Nurse-Preceptorship-review

Report
Nurse Preceptorship
Overview of Theories, Frameworks, Key
Concepts, and Principles that Influence the
Knowledge, Skills, Abilities, and Judgment for
Becoming a Master Preceptor.
Becky Graner MS, RN 2014
1
Purpose: Provide an overview of theories, frameworks, key
concepts, and principles that influence the knowledge, skills,
abilities, and judgment for becoming a master preceptor.
Objectives
1. Define components for a preceptor program.
2. Review roles and expectations of the preceptor.
3. Review common theories, concepts, and frameworks related to
teaching/learning.
4. Review standards and principles related to becoming a nurse
preceptor.
Becky Graner MS, RN 2014
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Preceptor education is one part of a
comprehensive preceptor program
Preceptor
resources
Standard
preceptee
instructions and
mandatory preclinical
requirements
Preceptor
education
Full
preceptor
program
Sustaining and
rewarding
preceptors
Templates
individualized by
facilities and
institutions
Becky Graner MS, RN 2014
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Possible components for a preceptor program
Preceptor
education
Facility (clinical site) Academic
Resources
Recruitment &
retention
Online or face to
face workshop/
courses to provide
knowledge, skills,
attitudes, and
judgment congruent
for mastering
precepting
Contracts, facility
requirements for
clinical learning,
identification,
passwords, policy
and procedures
Library access (if
applicable), online
resources,
templates for
assignments,
contact info for
faculty, preceptor,
preceptee
Preceptor
/preceptee
matching service,
recognition/awards,
Course overview,
goals, objectives,
teaching strategies,
student, preceptor,
and course
evaluations.
Becky Graner MS, RN 2014
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Possible components for a preceptor program
Every program needs a basic review and or comprehensive education activity for new and or
experienced preceptors.
Preceptor education
Facility (clinical site)
Academic
Resources
Recruitment &
retention
Online or face to face
workshop/ courses to
provide knowledge, skills,
attitudes, and judgment
congruent for mastering
precepting
Contracts, facility
requirements for
clinical learning,
identification,
passwords, policy and
procedures
Course overview,
goals, objectives,
teaching
strategies,
student,
preceptor, and
course
evaluations.
Library access (if
applicable), online
resources,
templates for
assignments,
contact info for
faculty, preceptor,
preceptee
Preceptor
/preceptee
matching service,
recognition/awards
Preceptors will be expected to obtain and review the student’s program goals and objectives, that
material is provided by the specific educational institution. Students must have legal contracts in place
for clinical site placement and students will need to meet facility requirements (much the same as
employees of that facility).
Becky Graner MS, RN 2014
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This overview will focus on the advanced practice
registered nurse (APRN) serving as a preceptor.
Becky Graner MS, RN 2014
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This overview is for those who have some background knowledge in
the principles of teaching/ learning, in nursing education activity
development, the COPA model, and the IOM Core Competency &
QSEN principles.
Through out the presentation you will see the key symbol
This symbol alerts the preceptor of “key” material that is essential for
becoming a master preceptor. The preceptor is encouraged to explore
these topics fully by using the additional resources for learning
provided through out the presentation.
Becky Graner MS, RN 2014
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Roles the preceptor plays…
• Oversight/ supervision
• Evaluator
• Educator
• Socialization
• Role model
• Protector
• Boyer, S.A. (2008). Competence and innovation in preceptor development:
Updating our programs. Journal for Nurses in Staff Development, (24)2, E1-E6.
doi: 10.1097/01.NND.0000300872.43857.0b
Becky Graner MS, RN 2014
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What is expected of a preceptor?
Over sight
Evaluator
• Patient safety
• Safe environment
• Critical
thinking/reasoning
• Collaboration
Professional
practice
Preceptor &
preceptee
Socialization
Nurses care
for people
• Educator / learner
• Leadership role
• Nursing standards of
practice and performance
• Relationship building
• Role model
• Protector
• Ethics
• Advocacy
Becky Graner MS, RN 2014
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Preceptors facilitate the integration of theory and practice
with the learner, while keeping patients safe.
Theory application through evidence-based nursing actions is the
foundation for practice.
In discussing your role as a preceptor the review of theories, concepts, standards, and principles is
necessary to build a shared framework and language in this area of nursing practice.
Nursing education shares a set of theories, concepts, and principles that overlap with other
professions, such as, education, human development, psychology, sociology, and instructional
design.
We will briefly touch on these theories and frameworks related to these topics, resources for
further independent exploration will be provided within the context of the material presented on
the slides.
Becky Graner MS, RN 2014
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Oversight and evaluator: Patient safety
Evaluation in education is the appraisal of progress or lack of progress the student has achieved
in their quest to reach set goals. Evaluations can be done by the self, the preceptor, the faculty,
the patient/ family. Advanced practice nursing students often co-create learning goals.
Evaluation is Standard 6 in ANA’s standards of professional nursing practice. Evaluation in this
context is the appraisal of nursing process/actions in relation to patient/ family/ community
outcomes. There are a number of models that can be used to structure evaluations.
Results of evaluations are used to improve performance, improve outcomes, to change
processes.
To measure or evaluate one must know the expected competencies linked to the standards of
practice and performance for the APRN.
• What is Competency?
“An expected and measureable level of nursing performance that integrates knowledge, skills,
abilities, and judgment, based on established scientific knowledge and expectations for nursing
practice” (ANA, 2010, p. 64).
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Knowledge, skills, abilities, and judgment
• Knowledge
• Thinking, understanding of science/humanities, professional standards of practice,
insights gained from context, practical experiences, personal capabilities, leadership
performance
• Skills
• Psychomotor, communication, interpersonal, diagnostic
• Abilities
• Capacity to act effectively which requires: listening, integrity, knowledge of one’s
strengths and weaknesses, positive self regard, emotional intelligence, openness to
feedback
• Judgment
• Critical thinking, problem solving, ethical reasoning, decision-making
ANA (2010), p. 12-13.
Becky Graner MS, RN 2014
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Oversight and evaluator: Safe environment
• IOM: Core competencies in Nursing Education
•
•
•
•
•
Patient centered care
Interdisciplinary teams
EBP
Quality improvement
Informatics
• http://www.iom.edu/Reports/2003/health-professions-education-a-bridge-to-quality.aspx
• Quality and Safety in Education for Nurses (QSEN)
Defines the knowledge, skills and abilities needed for each of the competencies
•
•
•
•
•
•
Patient centered care
Teamwork/collaboration
EBP
Quality improvement (QSEN separates IOM’s QI into these 2 categories)
Patient safety
Informatics
• http://qsen.org/competencies/
Becky Graner MS, RN 2014
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Evaluation
• Who does it?
•
•
•
•
Faculty
Preceptor
Preceptee
Patients/families
• What does it contain?
• Competencies
• Where does it happen?
• In action (if appropriate, reflection in action during patient care)
• After action (reflection on action after patient care)
• How is it accomplished?
• Gap analysis
•
•
•
•
Formal written
Discussion
Testing
Reflection
• When does it happen?
• Formative (during the learning process: feedback, modifying instructions, clarifying)
• Summative (assessment of learning at the end of a set period: final exams, project, paper)
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One way to organize evaluation is to use the
COPA Model
A framework and process developed by Carrie Lenburg to promote
initial and continuing competence by integrating:
Competence for contemporary practice
Outcomes to be achieved for practice
Performance of essential competencies
Assessment structured for competence
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Lenburg’s Eight Core Practice Competencies
with Sub-skill Examples (COPA Model)
http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace
/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/
COPAModel.html
Assessment and Intervention Skills
• safety and protection
• assessment and monitoring
• therapeutic treatments and procedures
Becky Graner MS, RN 2014
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Communication Skills
• oral skills
•
•
•
•
talking, listening, with individuals
interviewing; history taking
group discussion, interacting
telling, showing, reporting
• writing skills
• clinical reports, care plans, charting
• agency reports, forms, memos
• articles, manuals
• computing skills (information processing; using computers)
• related to clients, agencies, other authorities
• related to information search and inquiry
• related to professional responsibilities
Becky Graner MS, RN 2014
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Critical Thinking Skills:
•
•
•
•
evaluation; integrating pertinent data from multiple sources
problem solving; diagnostic reasoning; creating alternatives
decision making; prioritizing
scientific inquiry; research process
Human Caring and Relationship Skills
• morality, ethics, legality
• cultural respect; cooperative interpersonal relationships
• client advocacy
Becky Graner MS, RN 2014
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Management Skills
•
•
•
•
administration, organization, coordination
planning, delegation, supervision of others
human and material resource utilization
accountability and responsibility; performance appraisals and QI
Leadership Skills
•
•
•
•
collaboration; assertiveness, risk taking
creativity, vision to formulate alternatives
planning, anticipating, supporting with evidence
professional accountability, role behaviors, appearance
Becky Graner MS, RN 2014
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Teaching Skills
• individuals and groups; clients, coworkers, others
• health promotion; health restoration
Knowledge Integration Skills:
• nursing, healthcare and related disciplines
• liberal arts, natural and social sciences, and related disciplines
Becky Graner MS, RN 2014
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Oversight and evaluator:
Critical Thinking /reasoning
To facilitate growth/sophistication in critical thinking/reasoning a framework
provides the preceptor a guide to use with the learner that fosters thinking/
reasoning/ clinical judgment. It also provides a method for providing
feedback to the learner by establishing a shared language and way to
organize or label one’s actions.
One such model is Tanner’s Integrative Model of Clinical Judgment.
• Noticing – a perceptual grasp of the situation on hand – determined by the
nurse’s expectations (based on his/her knowledge base)
• Interpreting – developing a sufficient understanding of the situation to respond
• Responding – deciding on the course of action deemed appropriate for the
situation, which may include “no immediate action”
• Reflecting – attending to the patients’ responses to the nursing action which in
the process of acting “reflecting-in-action” and or “reflecting-on-action”
Becky Graner MS, RN 2014
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Dr. Christine Tanner’s Integrative Model of Clinical Judgment
Tanner, C.A. (2007) Thinking Like a Nurse: a research based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211.
Becky Graner MS, RN 2014
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Collaboration Competencies: The development of
interprofessional competencies by health professions students as part of the
learning process, so that they enter the workforce ready to practice effective
teamwork and team-based care. These competencies provide a basis for actions
that the preceptor is expected to role-model/ evaluate and the preceptee is
expected to assimilate by acquisition of knowledge, skills, abilities, and judgment.
Core Competencies for Interprofessional Collaborative Practice
Competency Domain 1: Values/Ethics for Interprofessional Practice
Competency Domain 2: Roles/Responsibilities
Competency Domain 3: Interprofessional Communication
Competency Domain 4: Teams and Teamwork
 http://www.aacn.nche.edu/education-resources/ipecreport.pdf
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Professional Practice: Educator/ Learner
• Adult learning principles
• Learning taxonomy
• Generational /experience considerations
• Learning / teaching styles
• Instructional design
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Professional Practice: Educator/ Learner
• Common learning theories
• Adult learning theory by Malcolm Knowles (andragogy)
• See next slide
• Transformative learning theory (Mezirow)
• Experience, critical reflection, development
• Preceptor help preceptees become aware and critical of assumptions and experiences.
• View from different and new perspectives
• Social learning theory (Bandura)
• Learning through observing and modeling
• Attention, retention, reproduction, motivation
• Hierarchy of Needs theory (Maslow)
• Preceptors awareness of preceptees needs influence learning
Becky Graner MS, RN 2014
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Professional Practice: Educator/ Learner
• Adult learning principles (Knowles)
1. Learners need to know: why what how
2. Self concept of learner: autonomous, self-directed
3. Prior experiences of learner: resource, mental models
4. Readiness to learn: life-related, developmental task
5. Orientation to learning: problem centered, contextual
6. Motivation to learn: intrinsic value, personal pay-off
Becky Graner MS, RN 2014
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Professional Practice: Educator/ Learner
• Learning taxonomy (classification for information or a mechanism
that categorizes how things relate to each other) (Ulrich, 2012, p. 79).
• Bloom’s taxonomy: Objectives and Domains of learning
• http://epltt.coe.uga.edu/index.php?title=Bloom's_Taxonomy
• Fink’s taxonomy of significant learning
• Fink, L. D., (2003). Creating Significant Learning Experience. San Francisco, CA:
Jossey-Bass
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Revised Bloom’s Taxonomy
evaluation
creating
synthesis
evaluating
analysis
analyzing
application
applying
comprehension
understanding
knowledge
remembering
Bloom, 1956
Anderson & Krathwohl, 2001;
Krathwohl, 2002
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Fink’s taxonomy of significant learning
1. Foundational knowledge: understand and
remember
2. Application: skills, thinking, managing
3. Integration: see and understand connections
among different things
4. Human dimension: learning about oneself
and others
5. Caring: developing new feelings, interests,
values
6. Learning how to learn: becoming a better
student, inquiring, self-directed
For learning to occur there MUST BE some type
of change in the learner… no change- no
learning. (Fink, 2003)
Becky Graner MS, RN 2014
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Professional Practice: Educator/ Learner
• Generational /experience considerations
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAP
eriodicals/OJIN/JournalTopics/TheMultigenerationalWorkforce
Becky Graner MS, RN 2014
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Professional Practice: Educator/ Learner
• Learning styles
• How individuals receive and process information, how they store information
in the brain and how they retrieve and use the information.
• Kolb http://academic.regis.edu/ed202/subsequent/kolb2.htm
• Benner’s novice to expert
• Novice, advanced beginner, competent, proficient, expert
• Myer-Briggs Type Indicator
•
•
•
•
Extroversion
Sensing
Thinking
Judgment
Becky Graner MS, RN 2014
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Professional Practice: Educator/ Learner
• Instructional design is . . .
• The practice of creating "instructional experiences which make the
acquisition of knowledge and skill more efficient, effective, and
appealing.”
• The process consists broadly of determining the current state and
needs of the learner, defining the end goal of instruction, and creating
some "intervention" to assist in the transition. Ideally the process is
informed by pedagogically (process of teaching) and andragogically
(adult learning) tested theories of learning and may take place in
student-only, teacher-led or community-based settings.
• There are many models but common parts are: analysis, design,
development, implementation, and evaluation (sound familiar?)
Becky Graner MS, RN 2014
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Professional Practice: Nursing standards of
practice and performance
ANA’s Scope and Standards of Practice and Professional Performance
Standards for Registered Nurses and additional competencies for the
graduate level prepared specialty nurse and the APRN
http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurs
es
North Dakota Standards of Practice
http://www.legis.nd.gov/information/acdata/html/54-05.html
Becky Graner MS, RN 2014
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Relationship between Educational Competencies,
Licensure and Certification
Competencies
Measures of competencies
Identified by Professional
Organizations
(e.g. oncology, palliative
care, CV)
Specialty Certification
Specialty
CNP, CRNA, CNM, CNS in
Population context
Population Foci
Role
APRN Core Courses:
Patho/phys,
Pharmacology,
physical/health assess
Licensure: based
on Education
And certification**
APRN
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Professional Practice: Nursing standards of
practice and performance
The Consensus Model for APRN Regulation, Licensure, Accreditation,
Certification and Education
https://www.ncsbn.org/4213.htm
Becky Graner MS, RN 2014
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Professional Practice: Leadership Role
• Every nurse in every setting- the expectations of advanced practice
• Leadership Standard 12 of ANA’s Standards of professional Nursing
Practice adds five (5) competencies for the graduate level nurse.
• Influences decision-making bodies to improve the professional practice
environment and healthcare consumer outcomes
• Provides direction to enhance the effectiveness of the interprofessional team.
• Promotes APN and role-development by interpreting its role for healthcare
consumers, families, and others.
• Models expert practice to interprofessional team members and healthcare
consumers.
• Mentors colleagues in the acquisition of clinical knowledge, skills, abilities,
and judgment.
(ANA, 2010, p. 56)
Becky Graner MS, RN 2014
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Socialization: Relationship building
• Introductions, expectations, and feedback
•
•
•
•
•
•
•
Introduces preceptee to team and others
Supports social needs
Supports adjustments to new role
Fosters integration into workplace culture
Helps establish communication between preceptee and management
Helps resolve conflicts
Ensures support of colleagues for socialization and orientation purposes
Becky Graner MS, RN 2014
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Socialization: Role model
• Transition to new role
• Transition is the psychological process one goes through to come to terms
with a new situation.
• It is not change (change is situational such as a new boss, new team, new
policy).
• Change is external and transition is internal.
• Stress management may view this process as grieving… shock & denial, pain &
guilt, anger & bargaining, depression, reflection & loneliness, upward turn,
reconstruction & working through, acceptance & hope.
Becky Graner MS, RN 2014
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Nurses care for people. . .Protector
• Ethics
• http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Codeof
EthicsforNurses/Code-of-Ethics.pdf (ANA Code of Ethics)
• http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ (International Code
of Ethics for Nurses)
• Advocacy
• Fundamental to nursing
• “ nursing is the protection, promotion, and optimization of health and
abilities, prevention of illness and injury, alleviation of suffering through the
diagnosis and treatment of human responses, and advocacy in the care of
individuals, families, communities, and populations” (ANA, 2010, p. 3).
• The nurse preceptor applies this nursing foundational belief/action to the
relationship with preceptees.
Becky Graner MS, RN 2014
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Nurses care for people. . . Protector
• The preceptor
• Protects the patient/family from novice error
• Protects the preceptee from making errors that might threaten self and
future.
• Provides a safe learning environment for the preceptee to learn and practice
• Supports developing skills
• Ensures adherence to policy and procedures
• Considers licensed scope of practice when assigning and delegating
• Protects the preceptee from adverse behaviors of others
• Adapted from Boyer, S. A. (2008). Competence and innovation in preceptor development:
Updating our programs. Journal for Nurses in Staff Development, (24) 2, E1-E6.
Becky Graner MS, RN 2014
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Resources for further learning
COPA Model
http://nursingworld.org/nursingcompetencies
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodical
s/OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.html
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodical
s/OJIN/TableofContents/Volume41999/No2Sep1999
Becky Graner MS, RN 2014
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Resources for further learning
Becky Graner MS, RN 2014
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