Becky Graner MS, RN 2014 1

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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Purpose: Provide an overview of theories, frameworks, key concepts, and principles that influence the knowledge, skills, abilities, and judgment for becoming a master preceptor. Objectives1. 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.

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Preceptor education is one part of a comprehensive preceptor

program

Full preceptor program

Preceptor resources

Preceptor education

Templates individualized by

facilities and institutions

Sustaining and rewarding preceptors

Standard preceptee instructions and mandatory

pre-clinical requirements

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Possible components for a preceptor programPreceptor 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,

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Possible components for a preceptor programPreceptor 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

Becky Graner MS, RN 2014

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).

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

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This overview will focus on the advanced practice registered nurse (APRN) serving as a preceptor.

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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.

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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

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What is expected of a preceptor?

Over sight

Evaluator

•Patient safety •Safe environment•Critical thinking/reasoning•Collaboration Professional

practicePreceptor & preceptee

•Educator / learner•Leadership role •Nursing standards of practice and performanceSociali

zation

•Relationship building•Role model Nurses

care for people

•Protector•Ethics •Advocacy

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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.

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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.

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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/

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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 practiceOutcomes to be achieved for practicePerformance of essential competenciesAssessment 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

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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

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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

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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

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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

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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”

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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.

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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 PracticeCompetency Domain 1: Values/Ethics for Interprofessional PracticeCompetency 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

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Professional Practice: Educator/ Learner• Adult learning principles (Knowles)1. Learners need to know: why what how2. Self concept of learner: autonomous, self-directed3. Prior experiences of learner: resource, mental models4. Readiness to learn: life-related, developmental task5. Orientation to learning: problem centered, contextual6. Motivation to learn: intrinsic value, personal pay-off

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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 Taxonomyevaluation

synthesis

analysis

application

comprehension

knowledge

creating

evaluating

analyzing

applying

understanding

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 things4. Human dimension: learning about oneself

and others5. Caring: developing new feelings, interests,

values6. 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)

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Professional Practice: Educator/ Learner• Generational /experience considerationshttp://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/JournalTopics/TheMultigenerationalWorkforce

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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

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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?)

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Professional Practice: Nursing standards of practice and performance ANA’s Scope and Standards of Practice and Professional PerformanceStandards for Registered Nurses and additional competencies for the graduate level prepared specialty nurse and the APRNhttp://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses

North Dakota Standards of Practice http://www.legis.nd.gov/information/acdata/html/54-05.html

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Relationship between Educational Competencies, Licensure and Certification

APRN

Role

Specialty

Competencies

Specialty Certification

Licensure: based on Education

And certification**

Identified by Professional

Organizations(e.g. oncology,

palliative care, CV)

Measures of competencies

CNP, CRNA, CNM, CNS inPopulation context

APRN Core Courses: Patho/phys,

Pharmacology, physical/health assess

Population Foci

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Professional Practice: Nursing standards of practice and performance The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Educationhttps://www.ncsbn.org/4213.htm

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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)

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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

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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.

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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.

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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.

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Resources for further learningCOPA Modelhttp://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

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Resources for further learning

Becky Graner MS, RN 2014