Presentation on theme: "Mentoring-Precepting: Transition from Novice Expert"— Presentation transcript:
1Mentoring-Precepting: Transition from Novice Expert Susan A. Boyer, RN, M.Ed.Vermont Nurses In PartnershipExecutive Director
2Mentoring & Precepting New graduates struggle with building capability as they enter into practiceIn new specialties even capable nurses revert to a novice level of capabilityThis morning we will explore what is needed to support transition along the continuum towards competenceas a nurse andas a preceptor in the clinical setting
3Objectives:Differentiate the practice of a colleague with consideration of "novice to expert" levels of capability.Build a teaching plan that fosters the development of critical thinking capability.Describe the impact of developmental support in the clinical setting.
4Experiential Learning Dreyfus' theory of experiential learningA developmental modelBenner worked with Dreyfus model of skill acquisition for 21 yearsApplication of experiential learning theory to the development of nursing practice
5Nursing Requires:Benner writes that nursing requires both Techne and PhronesisTechne – explicit knowledge related to procedural or scientific knowledgePhronesis – is more complex; it is reasoned practice that is developed through experiential learning, where the nurse is continually improving her or his practice
6TechneThe rational method involved in producing an object or accomplishing a goal/objectiveThe intent is making or doing, not simply "disinteresting understanding.“Also has meanings/implications that relate it to art – techne is the craft presentation of the art, in this case the art of nursing
7PhronesisThe virtue of moral thought, usually translated "practical wisdom”Aristotle - not only the ability to decide how to achieve a certain end, but also to reflect upon and determine that end, the ability to achievethe application of practical knowledge - knowledge framed by exposure to other perspectives, ideas and disciplies.
8Phronesis - More than Just knowledge To think about how and why we should act in order to change things, for the best.Gaining phronesis requires time, as one must gain both the habit and understanding of correct deliberationPhronesis is reasoned practice, employed through experiential learning, where the nurse is continually improving their practice
9Novice to expertNoviceAdvanced beginnerCompetentProficientExpert
10Traits and capabilities Framework, Berliner (1988); Years experience data from James Leach (1996)
11Transition between levels Transition does not equal time/yearsRegression when faced with new situation/specialtyTransition takes time and experienceExperiential learningReasoned practiceGain the habit and understanding of deliberationMove more quickly to next levelApply prior learningSee what the core concepts areSee how concepts can be applied in new situation
12Application to competence Development & evaluation Performance ScoringIdentified Limitation (Novice)Capable (Advanced Beginner)Performs Independently (Competent)ProficientExpert
13Scoring key categories 1 – Identified Limitation requires direct guidance & support, little or no experience with skill2 – Capable - familiar with skill/equipment, but may need assistance, seeks help when unfamiliar with process/skillBENNER’SNovice - Inflexible, rule-based. Little or no background understandingAdvanced Beginner – start to use and make sense of situational elements & depend on the context. Temporal focus is immediate & present
14Benner’s Competent 3 – Performs independently 4 – Proficient Increased efficiency, planning is still conscious, abstract, analytic, and deliberate.-situations are perceived as a whole rather than as unconnected aspects- Understanding of task, also the decision of what to do next, is intuitive and fluid.3 – Performs independentlyknowledgeable to perform these tasks safely as a result of training & experience4 – Proficientextensive experience in this area/skill, able to teach and mentor others5 – Expertall of the above; fluid performance; ensures evidence-based practice for clients and agency
15Transition from novice What supports development and transition along these levels of capability?
16To develop capability, competence & confidence Use reflection, questioning, story- telling, feedback, experience and success to foster developmentSupport holistic careFocus on concrete critical thinking development questions/discussionClearly defined expectationsA plan for the learning process
17What are the goals ?What patients need – a safe and effective care providerWhat a preceptor needs – evidence that this care provider can provide safe and effective careWhat will this evidence look like?
18Competency Expectations Clearly defined expectationsPerformance outcomes statementsWhat does a nurse do?What is most important?Tasks vs. PhronesisProcedures vs. Critical Thinking
19Concrete Teaching Plan Clinical teaching is more effective when it is plannedComponents of a teaching planGoalsClearly defined expectationsInstructional strategiesTeaching time is required for instruction, observation, allowing practice, giving feedback, documentation, discussion of case scenarios/stories/issues/what ifs.
20Critical elements - For planning Performance expectationsInstructional strategiesConcrete Critical Thinking Development
21Clinical Coaching Plans Instructional StrategiesPerformance ExpectationsMet?CommentsReflection on practice/learning(concrete C.T. development)
22Critical elements - for learner, for safety Identify and explore resourcesHow to find the info?Recognize limits of capabilitySeek help/assistance/information
23Fostering critical thinking skill development Assist with organization/prioritizationProvide reflection regarding aspects of a clinical situationFocus on concrete critical thinking development questions/discussionClearly defined expectationsA plan for the learning process
24Learning EnvironmentWhat every learner needs – a safe learning environmentBasic principles of teaching/learningSimple to complexSuccess builds successAllow practice, even failureAllow time for learning and discussingFeedback, Correction, Change directionSafety for patient and learner
25Experiential Learning Instruction in the clinical settingDifferentiating between performance outcomes and instructional strategiesDetermining behaviors that foster Critical Thinking development
26Critical Thinking: Novice Expert Data gathering from multiple sourcesDistinguish relevant from irrelevantIdentifies missing informationChecks accuracyPredicts beyond the presentationExtends thinking beyond the medical recordEvaluates differing points of viewIdentifies and examines alternativesFlexibility - change in assignmentWillingness to reconsiderAnticipates & Manages complications
30History of VNIP What we have learned Measurable outcomes - help to ‘sell the concepts/program’The value of standardization and collaborationExpectations for the future of this collaborative project
31References:Benner, P. (2004). Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science, Technology & Society, 24,NCSBN Position paper (2005) Clinical Instruction in Prelicensure Nursing Programs. August Accessed on 3/21/08 at https://www.ncsbn.org/pdfs/Final_Clinical_Instr_Pre_Nsg_pr ograms.pdf