Communication, Coaching and Feedback, Evaluating Others Module 4 Objectives Recognize and role model effective communication Promote effective communication in others Explain the components of feedback that promotes growth Understand importance of developing a reflective practice Verbalize various strategies for evaluations Welcome to communication, coaching and feedback and evaluating others. Some preceptors find this area stressful. Hopefully you will find a few helpful tips and improve feedback skills to include, even if the student is not doing well, so that learning continues to take place without you feeling anxiety (end).

Communication Importance Types Attitudes Barriers (such as SBAR) Lack of time Lack of comfort Lack of motivation The work environment Lack of honesty Failure to listen Let’s begin by talking about communication in general; it’s importance, the different types, the role attitude plays, and the barriers to effective communication. Importance: The quality of communication among health care team members influences patient care outcomes, its that important One way to standardize and thus improve our communication is the use of SBAR. SBAR stands for situation, background, assessment, recommendation. If you are unfamiliar with this tool, there is a good article on this subject in the reference section. I strongly recommend you have your preceptee follow a format to give clear concise communication Types: Communication does not happen just one way, We are all familiar with verbal communication, but the nonverbal can be just as important. There is also visual and written communication, which has its own pros and cons. Attitude has to do with the whole communication package. There is the spoken word, and there is also body language or nonverbal, but there is also your voice or tone, pace, touch ect Barriers to clear communication. Sometimes these barriers cannot be completely avoided, but an awareness to these barriers can improve the overall communication. lack of time lack if comfort lack of motivation the work environment providing answers , rather than suggestions lack of honesty inability to accept criticism failure to listen

Feedback How Am I Doing? Helps improve performance Decrease turnover Coaching and feedback Feedback Helps improve performance Decrease turnover Motivates self-improvement Builds trust How Am I Doing? Nearly everyone wants an answer to this question. Feedback can…do the things mentioned here,(Erven, 2001, Evaluating performance and providing feedback to emplyees) however, it can also have the direct opposite effect if done poorly. Feedback can enhance learning when the learner believes they are making progress. When feedback is only negative, it is defeating, and the desire to change is not as strong

Purpose of feedback is to promote growth Doing it well Timely Honest Focus on skill, not person Motivation is on performance improvement Balance the positive and the negative We want to learn to consistently provide the type of feedback that will promote growth. We must ask ourselves what is our motivation. Problems arise when there is a difference between a preceptee’s performance and the precetor’s expectations. Make sure desired tasks and expectations are clearly defined. Any differences must be identified and than analyzed. Determine if the problem is a learning deficient or from unclear expectations. If it is a lack of knowledge, provide the necessary education, if a misunderstanding of expectation, refine and clarify. So when you are giving feedback, remember its purpose is to promote growth. Ways to “do it well” include; give timely feedback- avoid collecting items for all at once. Feedback is most effective when closest to the event (of course, care is given to location, so if an error is to occur at the patient bedside, you most stop the action but give feedback outside the room, away for the patient). It is easy when someone is learning, that they may make frequent, what one might consider “small” mistakes, and maybe you chose to overlook these, but then, something happens and you bring up all the other times they made the mistake and you said nothing. Try not to do that, it can be discouraging, since the learner is not aware there have been mistakes in the past, then they cannot correct them. Be Timely Honest- focus your attention, be direct, and express yourself fully. Be open to listen to their “side of the story” sort of speak. Honesty is critical for behavior to change, but honesty can be difficult, particularly when you are working to build this trusting, open relationship, and now you have to tell them how they did not do something very well. That’s where the next one comes in- Focus on the skill/behavior, not the person- avoid making judgments, these are perceived as subjective , address behaviors that can be changed. This is not hard, but it takes an awareness. It is easy to say “ you…missed an opportunity or you forgot to do something” instead “when completing an assessment, follow the same routine, that way you will not forget anything, even if you are interrupted” Remember, the motivation is on performance improvement, reflect on personality style differences and consider individual values, just because someone does something a little different from you, does not automatically make it wrong. When giving the feedback, balance the +/-, let them know what was done right is just as important as what was not done right, and it makes it easier to “hear” what was not done right. Phrase your feedback in a positive, “next time try “ instead of “don’t do that”. This idea is also discussed in your preceptor handbook as the feedback sandwich. By following the formula to reinforce In providing feedback, be specific- distinguish between the parts of the encounter, don’t just throw the encounter away. For instance And remember, praise is a from of feedback, give it as it is earned Everyone makes mistakes, what is important is how we communicate and encourage change so mistakes are not repeated. This is done with patience and compassion.

Encourage self reflection As a means to provide feedback How did you think that went? Ask the student how they think a particular encounter went. This requires them to verbalize their thought process. What is the rationale for specific behaviors shows how we come to decisions. This approach encourages critical thinking and demonstrates reasoning skills. It is particularly useful for beginning students. It may help them to evaluate themselves and ask for further information how they could of done something differently. If their initial response is “I think it went well”, ask them why they feel that way, this encourages them to provide support for their answer . This probes for their understanding, was there a lack of knowledge, an attitude, or poor reasoning , how did they come to their decision.(Mastering the preceptor role: challenges of clinical teaching). Promoting self-reflection is something they will benefit from throughout their professional career, long after they have a preceptor, it teaches all of us to be accountable for our decisions and our actions

Strategies to Evaluate formal Review established goals for orientation Completed skills checklist, manage 4 patients Peer and self evaluation Rubrics- criterion based Report criteria Checklists SBAR, steps in a process Technology Computer quizzes There are many different formal evaluation tools available to assist you in the evaluation process. Formal evaluation is a written form of feedback that provides validation of your students abilities and competence. A common formal evaluation ios the establishment of goals and then periodically reviewing progress towards these goals. When specific behavioral objectives are written, this review process can promote honest conversations where expectations can be clarified and progress can be easily monitored. Subjective measures are also a piece of the total evaluation process. These qualities are not as easily defined or measured, such as flexibility, attitude, openness. This information can be obtained through peer and self evaluations. Utilizing different evaluation sources provides a more well rounded “picture” of your preceptee’s strengths and weaknesses. Some of these might be to develop specific criteria for a report and then have several nurses critique the preceptee’s shift report. Or develop checklists, like SBAR, or a consistent process to perform a physical assessment. You can even generate computerized quizzes or find them already developed in the internet, like distinguishing different heart and lung sounds. The import thing is to provide clear and direct information regarding performance in an honest, and thoughtful manner, as the student is learning to develop their own professional practice

Evaluations University of Wyoming FWWSN has an evaluation form in the preceptor handbook In doing evaluations, it is important to know what the expectations of the university are. There is an evaluation form in the preceptor handbook that you will be expected to complete at the end of this clinical course. Knowing end goals help you and your student to develop realistic weekly goals, and it may be helpful to discuss end goals periodically throughout the rotation. The students also have an evaluation they fill out on you, the preceptor. Again it is nice to know what aspects you are being evaluated on. You might want to take a look at it and then some time during your precepting, stop and ask the preceptee “how am I doing?” “Do you feel you are learning what you need to?”

Let us each and all realize the importance of our influence on others- stand shoulder to shoulder- and not alone, in good cause Florence Nightingale This concludes the preceptor workshop. I hope that somehow this class has stirred a renewed commitment to nursing and a dedication to the importance of your own professional growth, and that you take some satisfaction from playing a role in the growth and development of your student nurse. To pay it forward Alison Smedley writes “ if nurses are to be involved with shaping their own future, they must accept responsibility for the educational development of quality role models for the new generation of nurses… Nursing must value and support its own profession and produce strong leaders dedicated to upholding the values and value of nursing” So with that in mind, as Florence instructs us “let us each and all realize the importance of our influence on others- stand shoulder to shoulder- and not alone, in good cause” Thank you  

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References University of Memphis (2010). Effective intern evaluation. Retrieved from, http://www.memphis.edu/hss/clnt/preceptor- training.htm University of Wyoming. (2009). Professional preceptor handbook: A resource guide for nurses in partnership with the Fay W. Whitney School of Nursing. Retrieved from, http://uwadmnweb,uwyo,edu/nursing/info.asp?p=6075 Vermont Nurse Internship Program. (2005). Preceptor development. Retrieved from, http://www.vnip.org/preceptor.html

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