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Nurse Preceptorship . Overview of Theories, Frameworks, Key Concepts, and Principles that Influence the Knowledge, Skills, Abilities, and Judgment for Becoming a Master Preceptor. .

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Nurse Preceptorship


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    1. 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

    2. 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 • Define components for a preceptor program. • Review roles and expectations of the preceptor. • Review common theories, concepts, and frameworks related to teaching/learning. • Review standards and principles related to becoming a nurse preceptor. Becky Graner MS, RN 2014

    3. Preceptor education is one part of a comprehensive preceptor program Becky Graner MS, RN 2014

    4. Possible components for a preceptor program Becky Graner MS, RN 2014

    5. Possible components for a preceptor program Every program needs a basic review and or comprehensive education activity for new and or experienced preceptors. 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

    6. This overview will focus on the advanced practice registered nurse (APRN) serving as a preceptor. Becky Graner MS, RN 2014

    7. 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

    8. 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

    9. What is expected of a preceptor? Becky Graner MS, RN 2014

    10. 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

    11. 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). Becky Graner MS, RN 2014

    12. 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

    13. 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

    14. 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) Becky Graner MS, RN 2014

    15. 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 Becky Graner MS, RN 2014

    16. Lenburg’sEight 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

    17. 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

    18. 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

    19. 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

    20. 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

    21. 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

    22. Dr. Christine Tanner’s Integrative Model of Clinical JudgmentTanner, 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

    23. 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 Becky Graner MS, RN 2014

    24. Professional Practice: Educator/ Learner • Adult learning principles • Learning taxonomy • Generational /experience considerations • Learning / teaching styles • Instructional design Becky Graner MS, RN 2014

    25. 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

    26. Professional Practice: Educator/ Learner • Adult learning principles (Knowles) • Learners need to know: why what how • Self concept of learner: autonomous, self-directed • Prior experiences of learner: resource, mental models • Readiness to learn: life-related, developmental task • Orientation to learning: problem centered, contextual • Motivation to learn: intrinsic value, personal pay-off Becky Graner MS, RN 2014

    27. 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 Becky Graner MS, RN 2014

    28. Revised Bloom’s Taxonomy Bloom, 1956 Anderson & Krathwohl, 2001; Krathwohl, 2002 Becky Graner MS, RN 2014

    29. Fink’s taxonomy of significant learning Foundational knowledge: understand and remember Application: skills, thinking, managing Integration: see and understand connections among different things Human dimension: learning about oneself and others Caring: developing new feelings, interests, values 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

    30. Professional Practice: Educator/ Learner • Generational /experience considerations http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/JournalTopics/TheMultigenerationalWorkforce Becky Graner MS, RN 2014

    31. 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

    32. 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

    33. 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/AdvancedPracticeNurses North Dakota Standards of Practice http://www.legis.nd.gov/information/acdata/html/54-05.html Becky Graner MS, RN 2014

    34. Relationship between Educational Competencies, Licensure and Certification Competencies Measures of competencies Identified by Professional Organizations (e.g. oncology, palliative care, CV) Specialty Certification Specialty Population Foci CNP, CRNA, CNM, CNS in Population context Licensure: based on Education And certification** Role APRN Core Courses: Patho/phys, Pharmacology, physical/health assess APRN Becky Graner MS, RN 2014

    35. 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

    36. 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

    37. 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

    38. 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

    39. Nurses care for people. . .Protector • Ethics • http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/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

    40. 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

    41. Resources for further learning COPA Model http://nursingworld.org/nursingcompetencies http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.html http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999 Becky Graner MS, RN 2014

    42. Resources for further learning Becky Graner MS, RN 2014