SAGE: Preceptor Roles

1. SAGE: Preceptor Roles Overview of Theories, Frameworks, Key Concepts, and Principles that Influence the Knowledge, Skills, Abilities, and Judgment for Mastering the Role of Preceptor.

2. The purpose for this presentation is to provide an overview of theories, frameworks, key concepts, and principles that influence the knowledge, skills, abilities, and judgment for mastering the role of preceptor. Objectives • 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.

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

4. This overview is for those who have some background knowledge in the principles of teaching/ learning and in nursing education activity development. Through out the presentation you will see the key symbol. This symbol alerts the preceptor of “key” material that is essential for mastering the role of preceptor. You will be alerted of the availability of further information when you see this star icon. You are encouraged to explore these topics by clicking on the links provided.

5. 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.

6. Roles expected of a preceptor: SAGE SAGE

7. Roles expected of a preceptor: SAGE SAGE

8. Socializer • The preceptor makes introductions, assesses expectations, and helps the preceptee filter and respond appropriately to 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

9. 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. • Transition to a new role can be very stressful, assisting the learner in managing stress /developing coping skills is important. Socializer

10. 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: Pathophys, Pharmacology, physical/health assess APRN

11. 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

12. Stress management • Change can precipitate grieving • shock & denial, • pain & guilt, • anger & bargaining, • depression, • reflection & loneliness, • upward turn, • reconstruction & working through, • acceptance & hope. • Preceptors need to be aware of the impact the stress response has on the person’s ability to learn. • Stress management techniques • http://www.mindtools.com/pages/main/newMN_TCS.htm Socializer

13. Roles expected of a preceptor: SAGE SAGE

14. Assessor 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 competencieslinked to the standards of practice and performance for the APRN.

15. Assessor • Who does evaluations? • Faculty • Preceptor • Preceptee • Peers • Patients/families • What do evaluations use to measure? • Competencies

16. Assessor • Where does an evaluation 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

17. Assessor • 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)

18. We hear the expression knowledge, skills, abilities, and judgment used often, what do they mean? • 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. Assessor

19. Competencies. . . “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) Assessor

20. 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 Assessor

21. 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/ Assessor

22. One way to organize the evaluation process 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 Assessor

23. 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 Assessor

24. Assessor 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

25. Assessor 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

26. Assessor 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

27. Assessor 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

28. Resources for further learning COPA Model http://www.youtube.com/watch?v=wekBgzn5aPU&feature=player_embedded (Video) 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 Assessor

29. 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 Assessor

30. 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” Assessor

31. 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. Assessor

32. Resources for further learning Tanner’s Clinical Judgment Model Tanner, C.A. (2006). Thinking like a nurse: A research based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211. Schoessler, M. (2013). Tanner’s Model of Clinical Judgment Applied to Preceptorship: Part 1. Journal for Nurses in Professional Development, 274-275. Schoessler, M. (2013). Tanner’s Model of Clinical Judgment, Part 2. Journal for Nurses in Professional Development, 335-337. Assessor

33. Roles expected of a preceptor: SAGE SAGE

34. Guardian • 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 • Assists the preceptee to cope with stress • 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.

35. 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 • http://rnjournal.com/journal-of-nursing/the-power-of-preceptorship • “ 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. Guardian

36. Roles expected of a preceptor: SAGE SAGE

37. The preceptor will need basic knowledge of: Educator • Adult learning principles • Learning taxonomy • Generational /experience considerations • Learning / teaching styles • Instructional design

38. 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 Educator http://www.qotfc.edu.au/resource/?page=65375

39. Other Common Learning Theories • 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 • Preceptors need to be aware of their actions as it could strongly influence the actions of their preceptees. • Hierarchy of Needs theory (Maslow) • Preceptors need to be aware of preceptees needs as it influences learning Educator

40. Learning taxonomy (classification for information or a mechanism that categorizes how things relate to each other) (Ulrich, 2012, p. 79). • Fink’s taxonomy of significant learning • Fink, L. D., (2003). Creating Significant Learning Experience. San Francisco, CA: Jossey-Bass • https://www.psychologicalscience.org/index.php/publications/observer/2011/september-11/using-finks-taxonomy-in-course-design.html • Bloom’s taxonomy: Objectives and Domains of learning • http://epltt.coe.uga.edu/index.php?title=Bloom's_Taxonomy Educator

41. 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). • Fink, L. D., (2003). Creating Significant Learning Experience. San Francisco, CA: Jossey-Bass Educator

42. Revised Bloom’s Taxonomy Educator Anderson & Krathwohl, 2001; Krathwohl, 2002 Bloom, 1956 http://www.nwlink.com/~donclark/hrd/bloom.html

43. Generational /experience considerations for preceptors: Educator

44. Generational /experience considerations resources: The Journal of Issues in Nursing (OJIN) #30 The multigenerational workforce series. http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/JournalTopics/TheMultigenerationalWorkforce Bell, J.A. (2013). Five generations in the nursing workforce: Implications for nursing professional development. Journal for Nurses in Professional Development, 29(4), 205-210. Educator

45. 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 • http://currentnursing.com/nursing_theory/Patricia_Benner_From_Novice_to_Expert.html • Myer-Briggs Type Indicator • Extroversion • Sensing • Thinking • Judgment • http://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/the-16-mbti-types.asp Educator

46. What kind of a learner are you? • VARK is a questionnaire that provides users with a profile of their learning preferences. These preferences are about the ways that they want to take-in and give-out information. • http://www.vark-learn.com/english/page.asp?p=questionnaire • Index of Learning Styles Questionnaire • http://www.engr.ncsu.edu/learningstyles/ilsweb.html Educator

47. 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?) Educator

48. Every nurse in every setting – the expectations of advanced practice in leadership • 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) Educator

49. 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 Educator

50. . . . “the art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move toward desired goals in a fulfilling manner” . . . Being a preceptor is . . . The Inner Game of Golf, W.T. Gallwey, 2000