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Mentoring-Precepting: Transition from Novice Expert Susan A. Boyer, RN, M.Ed. Vermont Nurses In Partnership Executive Director.

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Presentation on theme: "Mentoring-Precepting: Transition from Novice Expert Susan A. Boyer, RN, M.Ed. Vermont Nurses In Partnership Executive Director."— Presentation transcript:

1 Mentoring-Precepting: Transition from Novice Expert Susan A. Boyer, RN, M.Ed. Vermont Nurses In Partnership Executive Director

2 Mentoring & Precepting New graduates struggle with building capability as they enter into practice In new specialties even capable nurses revert to a novice level of capability This morning we will explore what is needed to support transition along the continuum towards competence – as a nurse and – as a preceptor in the clinical setting 2

3 Objectives: 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. 3

4 Experiential Learning Dreyfus' theory of experiential learning A developmental model Benner worked with Dreyfus model of skill acquisition for 21 years Application of experiential learning theory to the development of nursing practice 4

5 Nursing Requires: Benner writes that nursing requires both Techne and Phronesis Techne – explicit knowledge related to procedural or scientific knowledge Phronesis – is more complex; it is reasoned practice that is developed through experiential learning, where the nurse is continually improving her or his practice 5

6 Techne The rational method involved in producing an object or accomplishing a goal/objective The 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 6

7 Phronesis The 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 achieve the application of practical knowledge - knowledge framed by exposure to other perspectives, ideas and disciplies. 7

8 Phronesis - 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 deliberation Phronesis is reasoned practice, employed through experiential learning, where the nurse is continually improving their practice 8

9 Novice to expert Novice Advanced beginner Competent Proficient Expert 9

10 Traits and capabilities 10 Framework, Berliner (1988); Years experience data from James Leach (1996)

11 Transition between levels Transition does not equal time/years Regression when faced with new situation/specialty Transition takes time and experience – Experiential learning – Reasoned practice – Gain the habit and understanding of deliberation Move more quickly to next level – Apply prior learning – See what the core concepts are – See how concepts can be applied in new situation 11

12 Application to competence Development & evaluation Performance Scoring Identified Limitation (Novice) Capable (Advanced Beginner) Performs Independently (Competent) Proficient Expert 12

13 Scoring key categories 1 – Identified Limitation requires direct guidance & support, little or no experience with skill 2 – Capable - familiar with skill/equipment, but may need assistance, seeks help when unfamiliar with process/skill 13 BENNER’S Novice - Inflexible, rule-based. Little or no background understanding Advanced Beginner – start to use and make sense of situational elements & depend on the context. Temporal focus is immediate & present

14 3 – Performs independently – knowledgeable to perform these tasks safely as a result of training & experience 4 – Proficient – extensive experience in this area/skill, able to teach and mentor others 5 – Expert – all of the above; fluid performance; ensures evidence-based practice for clients and agency 14 Benner’s Competent - 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.

15 Transition from novice What supports development and transition along these levels of capability? 15

16 To develop capability, competence & confidence Use reflection, questioning, story- telling, feedback, experience and success to foster development Support holistic care Focus on concrete critical thinking development questions/discussion Clearly defined expectations A plan for the learning process 16

17 What are the goals ? What patients need – a safe and effective care provider What a preceptor needs – evidence that this care provider can provide safe and effective care What will this evidence look like? 17

18 Competency Expectations Clearly defined expectations Performance outcomes statements ◦ What does a nurse do? ◦ What is most important? ◦ Tasks vs. Phronesis ◦ Procedures vs. Critical Thinking 18

19 Concrete Teaching Plan Clinical teaching is more effective when it is planned Components of a teaching plan – Goals – Clearly defined expectations – Instructional strategies – Teaching time is required for instruction, observation, allowing practice, giving feedback, documentation, discussion of case scenarios/stories/issues/what ifs. 19

20 Critical elements -For planning Performance expectations Instructional strategies Concrete Critical Thinking Development 20

21 Clinical Coaching Plans Instructional Strategies Performance Expectations Met?Comments 21 Reflection on practice/learning (concrete C.T. development)

22 Critical elements - for learner, for safety Identify and explore resources How to find the info? Recognize limits of capability Seek help/assistance/information 22

23 Fostering critical thinking skill development Assist with organization/prioritization Provide reflection regarding aspects of a clinical situation Focus on concrete critical thinking development questions/discussion Clearly defined expectations A plan for the learning process 23

24 Learning Environment What every learner needs – a safe learning environment Basic principles of teaching/learning – Simple to complex – Success builds success – Allow practice, even failure – Allow time for learning and discussing – Feedback, Correction, Change direction – Safety for patient and learner 24

25 Experiential Learning Instruction in the clinical setting Differentiating between performance outcomes and instructional strategies Determining behaviors that foster Critical Thinking development 25

26 Critical Thinking: Novice Expert Data gathering from multiple sources Distinguish relevant from irrelevant Identifies missing information Checks accuracy Predicts beyond the presentation Extends thinking beyond the medical record Evaluates differing points of view Identifies and examines alternatives Flexibility - change in assignment Willingness to reconsider Anticipates & Manages complications 26

27 Support for Internship/Orientation 27

28 Teaching preceptors Communication Interpersonal skills How to provide experiential learning while protecting safety Teaching how to teach, how to foster critical thinking development 28

29 29

30 History of VNIP What we have learned Measurable outcomes - help to ‘sell the concepts/program’ The value of standardization and collaboration Expectations for the future of this collaborative project 30

31 REFERENCES: 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 ograms.pdf ograms.pdf 31

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