What we believeDr Haim Ginott (Adapted)

I possess tremendous power to make someone’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I

can humiliate or humour, hurt or heal. In all situations it is MY response that decides if a crisis will be escalated or de-escalated and a

person humiliated or humanised.

Preceptor ProgrammeCMDHB

Welcome

House Rules for Preceptor Study Day

We are all ambassadors for our organisation

What does this mean?

Objectives• Discuss the principles of Preceptorship• Discuss process of socialisation• Discuss characteristics of adult learning

styles• Identify and discuss strategies for effective

communication

What is Preceptorship?

Preceptorship

• Preceptorship according to the literature……

• How does this relate to your understanding

Mentorship vs Preceptorship

• What is the difference?• Who needs a mentor ?

What are the benefits of preceptorship?

Aims & Gains….

What are the challenges of preceptorship?

Reality vs Ideal

Preceptorship programme at CMDHB• Have preceptorship & orientation polices• 2 day training programme• Update forums available• 1(2): 1 relationship• Throughout whole orientation period-10 weeks• Regular feedback• Roster same shifts for 2 weeks (preceptee supernumerary)• Roster 2 - 3 same shifts per week for next 4 weeks• 12 month orientation- preceptorship for 12 weeks

Describe the roles & responsibilities of the preceptoring team

• Preceptor• Preceptee• Person in Charge• Nurse/Midwife Educator• Other staff

Socialisation

–What is socialisation?

4 stages of socialisation

• Honeymoon• Shock• Recovery• Resolution

• Describe your experience arriving on the first day of a new job.

• Describe your thoughts and feelings at the time. What did you do?

• What do you do to welcome new staff?• Identify some barriers to effective

socialisation

Describe the different needs of a:• Student• Graduate Nurse/Midwife• Experienced Nurse/Midwife • Overseas trained Nurse/Midwife

Internationally Educated Nurses/Midwives

Important to discuss with them their previous working experiences, here are some examples:

• Teamwork and autonomy• Nurse: patient ratios• Patient hygiene• Nutrition• Patient advocacy and consent • Discussions with doctors/senior staff• Communication –handovers, documentation practices• Rules around gender based issues What are the differences here at CMDHB?

Learning styles

Does Teaching = Learning?

What is learning?

What can influence learning?

Consider• Environment• Personalities• Emotional

• What can you do to impact these things?

Your learning style:

VARK

What are characteristics of adult learners?

Teaching a Practical Skill

Teaching a practical skill…• Recognition of prior learning

• Find out what others already know

• Tailor the knowledge to their needs not yours

Teaching a practical skill cont…• The “know how”

• Make sure that you have everything that you need before you start

• Make sure your environment is right– Not too noisy/busy

– Not too many onlookers

– Not too much at stake

• Explain rationale for task

• Demonstrate the entire skill at a normal speed

• Discuss expected outcomes– What’s normal what’s not

• Break skill down into small logical steps– Repeat explanation if necessary

– State why each step is important

• Demonstrate at slow speed

– If too fast may miss vital part of task

• Have learner demonstrate back to you to ensure learning has occurred

• Discuss/reflect– How was it for them?

– Would they be able to repeat task under “normal”circumstances?

– Can they explain why they are doing what they are doing?

Communication

Critical thinking

• What is critical thinking?

• What is the challenge for preceptors?

• ACTIVITY: Your client wants you to construct a tower using the blocks providedAssess & Planning: 7 minutes

During this time you can consult with your client

Implementation: 4 minutesEvaluation: 5 minutes

• “Critical thinking is the ability to deconstruct events and to reason the origins of situations (Brookfield 1987). Like reflection it involves considering what has gone before and what may yet happen (Clark & Holt 2001). There is a retrospective and a prospective or creative dimension to it (Daly 1998). Critical Thinking involves considering the relationship between events –whether this is the cause and effect or whether there is a more general process underway.”

• Price, A. “Encouraging reflection and critical thinking in Practice.” Nursing Standard. August 4/Volume 18/no.47/2004

• Knowledge• Assessment• Clinical Expertise• Preceptorship• Financial Accountability• Change• Ward Culture

What is communication?

• DialogueConversation between 2 or more people, discussion, verbal interchange of thought.

• Constructive Communication….Serving to improve, helpful, positive, practical, productive.

Communication is…..

So……• What is Ineffective communication?

• What is Effective communication?

• Communication exercises

Effective listening: SOLER• Sit forward• Open posture• Lean forward• Eye contact• Relax

Effective communication- HEARD• Honest

• Explicit

• Appropriate

• Respectful

• Direct

Problem solving • Define and clarify the problem

• Discover and understand the cause(s)

• If lots of problems determine the most effective to work on

• Think of solutions

• Monitor and evaluate outcomes

Some Questions to Ask• Who owns the problem• What is the problem• Whose behaviour causes the problem? Is this the

person you intend to confront? (if not, are there good reasons for you confronting someone else?)

• How important is the issue to me?• How important is the relationship to me? (the more

important the relationship, the more important it is to be open and spontaneous about so-called minor grievances)

Summary- good communication• H- Honest• E- Explicit• A- Appropriate• R- respectful• D- Direct

• H-Honours• E- elicits• A- Asks• R- Reflects

• S- Sit up• O- Open posture• L- Lean forward• E- Eye contact• R- Relax

• Baron story

Preceptor ProgrammeCMDHB

Day two

Objectives• Discuss the principles of assessment & its

application to CMDHB assessment of practice process

• Demonstrate a range of questioning and reflective techniques

• Demonstrate the ability to give constructive feedback in a respectful manner

• Identify debriefing strategies• Describe the appeal process

Principles of assessment

Assessment.

• Why assess?• When are we assessing?• What are our responsibilities? • who do we assess ?• Who can assess?

Health Practitioners Competence Assurance Act (2003)o Provides one legislative framework

for regulation of health practitioners

o Allows for consistent procedures & terminology across professions

Principle purpose . . .Principle purpose . . .o To protect the health & safety of the public

o To provide mechanisms to ensure practitioners are competent & fit to practice their professions for the duration of their professional lives

o Allowed authorities to prepare & consult on “scopes of practice” (18 September, 2004)

Assessment of Practice• Certify, promote, select, appoint, rank, predict,

diagnose and analyse. Cox (1982, p.180)• Establish standards, facilitate consistency and

quality• Provide diagnostic feedback to the practitioner to

develop learning agenda or corrective action (Waddell, 2001, p 104)

• Links PDRP into practice, evidence to support application

Learning Contracts

Acknowledgment to: Liz Pillay, Kathryn McWatt, Melanie Acknowledgment to: Liz Pillay, Kathryn McWatt, Melanie Lanigan, Kay Syminton for their work on learning Lanigan, Kay Syminton for their work on learning contracts, 2008 contracts, 2008

Learning ContractAn agreement between a learner and an educator that specifies in detail

• Learning objectives• The resources and strategies required to

accomplish the objectives• The evidence required to demonstrate the

objectives have been accomplished• The specific criteria for evaluationSoloman (1992) as cited in Matheson 2003.

Advantages• They individualise learning,

resulting in increased learner commitment and motivation

• They bring focus to student activities and generate a sense of ownership of the learning process

• Make learning explicit• They foster independence and

develop problem-solving skills• Help eliminate

misunderstandings

• They are flexible in meeting different learning needs, styles and paces of learning

• They develop some of the competencies required for successful self-directed learning

• Help set deadlines & clarify when the outcome is achieved

• Help to identify relevant resources within the clinical setting.

Learning Objectives - SMARTER• Specific• Measurable• Attainable for the person, conditions & time frames• Relevant & results orientated• Targeted to the learner and desired level of learning• Engaging• Repeatable

Words to use• Describe• Position• Name• Measure• List• Contrast• Interpret• Construct• Identify• Report• Facilitate

• Compare• Demonstrate• State• Assemble• Conduct• Plan• Express• Evaluate• Test• Elicit• Prepare

Steps1. Identify your learning need2. Specify the tasks you set yourself (objectives)3. Specify ways of completing the task (strategies)4. Specify evidence of completion of the objective5. Review your contract6. Rewrite (if necessary)7. Carry out the contract8. Evaluate your learning

Example

Name:______________________ Date: ______________________

How can you show to yourself and others that you have met your learning outcomes? Proof!

What will you utilise to achieve your learning outcomes? Be specific- consider how you learn best.

What do you want to learn, develop or examine? Consider your current abilities.

Evidence/ outcome

Learning resources

Learning objective

Learning Objective (s) achieved Yes ___ No _______Signed:_______________________ Date: _____________N/ME : ________________________

Nursing Council of New ZealandNursing Council of New Zealando Nursing Council of NZ governs the practice of nurses

o Sets & monitors standards of registration -to ensure safe & competent care for NZ public

o As the responsible authority, the Council is committed to enhancing professional excellence in nursing

o (Nursing Council of New Zealand, 2005).

Four domains of competence for the Four domains of competence for the registered nurse scope of practiceregistered nurse scope of practiceo Domain one: Professional responsibility

Competencies: Professional, legal, ethical & cultural safety

o Domain two: Management of nursing careCompetencies: Client assessment & care

o Domain three: Interpersonal relationships Competencies: Interpersonal & therapeutic communication

o Domain four: Interprofessional health care & quality improvementCompetencies: Member of health care team evaluates effectiveness of care & promotes a nursing perspective within interprofessional team (Nursing Council of New Zealand, 2005).

Four domains of competence for the Four domains of competence for the enrolled nurse scope of practiceenrolled nurse scope of practiceo Domain one: Professional responsibility

This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgment and being accountable for own actions and decisions, while promoting an environment that maximises health consumers’ safety, independence, quality of life and health.

o Domain two: Management of nursing careThis domain contains competencies related to assessment and provision of nursing care for health consumers when working under the direction of a registered nurse.

o Domain three: Interpersonal relationships This domain contains competencies related to interpersonal communication with health consumers their families/whanau and other nursing and healthcare staff.

o Domain four: Interprofessional health care & quality improvementThis domain contains competencies related to promoting a nursing perspective within the interprofessional health care team and contributing to quality improvement.

Assessment tools

Competence

• What is competence??• Why do we assess competence??

What is Competence• How you would identify/define competence?

• What characteristics would you consider necessary when assessing a Graduate Nurse/Midwife, Competent Nurse/Midwife, Proficient Nurse/Midwife for their skill assessment?

Selecting the Measurement tool• We need to measure mastery of the competency

being measured• From a probability perspective we need to be sure

that every nurse has an equal chance of passing or demonstrating competency

• What features does the assessment tool need to ensure mastery of the competency and fairness to all

Features of the tools• Objectivity – Independent of perception• Enhanced by skill, task or procedure being

linked to CMDHB policies• Nothing 100% objective• Validity – Does it test the specific skill or

knowledge?

The Assessment Tools• Reliability - the consistency with which a test

measures what it is designed to measure (Quinn, 1995 cited in Chambers, 1998, p 205)

• Three components (Thorndike, 1988)• Rationale• Procedure• Analysis• Inter-rater reliability unknown (comparing

assessors)

CMDHB assessment tools

• Bondi scale• Competency and Audit

Competency and Audit tool

Generic Orientation elements throughout organisation for nurses

• Generic competencies• Auditing competencies

Assessment process

The Assessment Process• How would you organise a practice

assessment?

• What factors do you consider?

• Write on butcher paper your actions in order of priority.

The physical process

•Prepare - Criteria, knowledge & available time•Discuss - the assessment criteria and feed back process•Do the assessment - observing to criteria -* if issues arise address these respectfully•Feedback•Document assessment process

What are we looking for in an assessment?• Safe effective practice• That level indicated is achieved• All areas of assessment form are covered

when appropriate• Articulation of own performance• Rationales for actions can be explained• Patient is central to the process

Responsibility of the Assessor• Accountability (signing the form…. What does this mean?)

• Patient safety

• Professionalism

• You must be confident the candidate can repeat the performance

QuestioningWhat questions would you ask to :-

• Elicit rationale behind behaviour/actions• Elicit reflection on actions• Elicit evaluation of the event• Debrief after the process

The art of feedback

Art of feedback

• Feedback- needs to be F A S T• Frequent• Accurate• Specific• Timely

Setting the stage• Be realistic about the time necessary and set aside

sufficient time• Ensure both are sure about the purposes of the

meeting• Don’t attempt to take the other by surprise• State your preference for the process to be used,

e.g. you may want to start by putting your case succinctly, hear the others response then have a general discussion

Reinforcing feedback (constructive)

• Describe specifically what you observed• Describe the impact• Ask for their views or interpretation. Try to reconcile

differences• Ask what they have learnt or what they might do

differently next time• Offer any suggestions that could be useful or helpful• Scenario

Phrasing Feedback• Remember FAST• Constructive• Sincere• Plan

The One Minute PreceptorGet a commitment• What do you think is going on here?• What do you want to do?• If I weren't available-what would you do for this patient?

Probe for supporting evidence• What factors did you consider in making that decision?• Were their other options you considered and discarded• Listen carefully to understand the learners clinical reasoning and to ascertain any

deficits in their knowledge base

Teach general rules• Summarise anything from the key diagnosis, management of a demanding

patient or what is related to the patient you are discussing • Focus on important areas for them and the patient

Reinforce what was done right• Ask learners to identify what they did right and what they would like to do better• Reinforce behaviours that were highly effective

Correct mistakes• Suggest new behaviours that may be helpful in the future• well timed, expected, case specific, behaviour focussed feedback and use

descriptive language

Managing difficult situations

• What situations can occur…..

Managing Conflict• Methods – You win the other loses or you lose and

the other wins• Both are power based and if resolution appears to

have occurred conflict will re-surface• You win and other wins – working together to clarify

our respective problems/needs for a solution that meets each of our needs

• Non power based, conflict is generally resolved

The Denba Process• Description of the behaviour affecting you negatively – be

objective, brief and refer to most recent instance• Effects – of the behaviour on you, or feelings you have

about it. Use I statements, be brief and simple• Needs or preferences you have. Clear, brief, avoid labels• Benefit that will arise from the change. Benefits to you or

your view of the relationship• Agreement• Scenario

CALM Techniques• You cannot solve a problem when someone is in

crisis mode (i.e. in a highly aroused emotional state)• Identifying triggers and recognising the clues to

escalation is important• It’s far easier to prevent escalation, than to de-

escalate• Stay CALM: Composed, Assertive, Look confident,

Measured tone of voice

Competence not demonstrated

In the event of an assessment being made where the Bondi Scale is 4 or 5 in any of the domains

• 1. Complete Remedial Action Plan – reassess• 2. Competence not demonstrated then hand over

NE/CNM/TLIn the event of the competency audit tool not being

met assess how much further self directed learning needed and assist with the planning for this

• Competence not demonstrated then hand over NE/CNM/TL

Becoming an Assessor

To become an assessor• Successfully complete an assessment of you

undertaking an assessment of practice• Complete the assessment using the forms –practice

assessment form, CMDHB assessment of practices procedure

• Have assessment of practice procedure form endorsed by another assessor

• Competency Audit Tool Certification• A certificate and badge acknowledging successful

completion of the training will be issued

Conclusion• Discussion• Participant evaluation form

• “The koru is in silver with a red background• The Silver around the inside of the circle is the community of

Practice• The two koru represents the teacher and student• The koru is the matau (hook), the red background is the

whariki (mat) concealed below the mat is the matauranga(knowledge) for the student to gain that knowledge, will take hard work. The preceptor who has the knowledge and understanding will walk along side the student to give them a helping hand. The Maaori name for this level is Whariki.”