Transcript Clinical coaching plans and critical thinking development

Susan A. Boyer, RN, M.Ed.
Executive Director
Vermont Nurses In Partnership, Inc.
www.vnip.org susan.boyer
7/17/2015
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Develop strategies for critical thinking
development within the practice setting
 Discuss the framework for preceptor
development
 Determine specific, measurable criteria
for assessment of critical thinking,
leadership, management and
interpersonal relationship skills.
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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•
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
www.vnip.org
7/17/2015
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Developed Internship for multi-agency
use across the continuum of care
 Delivers programming that supports new
grad, new to specialty & precepting staff.
 Incorporates Clinical Competency
Development and Validation Goals
 Standardized preceptor & intern
development
[email protected]
www.vnip.org
© 2001 – 2007 Vermont Nurses In Partnership, Inc.
 “Nursing literature reports that the
inability to handle the intense working
environment, advanced medical
technology , and high patient acuity
results in new grad turnover rates of 35%
to 60% within the first year of
employment.”
 (Beecraft, Kunzman, & Krozek, 2001)
 VNIP turnover rate – less than 10% for
new
graduates
completing
the
internship
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying
without permission. [email protected]
7/17/2015
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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Preceptor development
and support
Preceptors
Clearly defined expectations
Standardized performance outcomes (COPA)
Interns
Clinical Coaching Plan
- Development of Critical Thinking
 What patients need – a safe and
effective care provider!
 What does a ‘safe and effective’
care provider look like?
 What is most important in their
practice?
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 What it is, what it looks like, how we do
it, HOW TO FOSTER ITS DEVELOPMENT!
 Teach preceptors, teach interns
 First we need to clearly define and
describe what critical thinking is
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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Think, Pair, Share:
 What does C.T. look like in your practice?
 How do we support the development of
Critical thinking skills?
www.vnip.org
[email protected]
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 How do you know that it is occurring?
 How does critical thinking relate to
competence development & validation?
 What does critical thinking look like in
your clinical practice setting?
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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Anticipates & Manages complications
Checks accuracy of data
Data gathering from multiple sources
Distinguish relevant from irrelevant
Extends thinking beyond the medical record
Evaluates differing points of view
Flexibility - change in assignment
Identifies and examines alternatives
Identifies missing information
Predicts beyond the presentation
Willingness to reconsider
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Questions
 Anticipate questions that might be asked
 Explore possible consequences
 Focus on outcome – what is the goal?
 Focus on the rationale – why?
 Explore alternatives – what else? what am I missing
 Case presentations, telling your ‘stories’,
sharing experiences
 Turn them into “what if” discussions
 Continue with the questions listed above
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[email protected]
© 2001 Vermont
Organization of Nurse
Leaders (VONL)
 Develop & use habits of inquiry
 Take enough time to explore situation
 Keep an open mind - Verify information
 Discuss
 What did I miss? How could this be made better?
Why are we doing it this way?
 Thinking out loud
 Did you notice… How can I find out . . . .
 I could do x, y or z,…. but for this patient, I think
this is best…. Why?
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[email protected]
© 2001 Vermont
Organization of Nurse
Leaders (VONL)
 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
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 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?
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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
List of tasks and procedures?
Inclusive of critical thinking
expectations?
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Relationship considerations?
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Ethics, leadership, other aspects?
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Clearly defined expectations
 Performance outcomes statements
 What does a nurse do?
 What is most important?
 Tasks vs. Phronesis
 Procedures vs. Critical Thinking
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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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.
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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Instructional Performance Met?
Strategies Expectations
Comments
Reflection on practice/learning
(concrete C.T. development)
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 Helps us to clearly define expectations!
 Expectations are worded in
performance outcomes statements
 Goals, performance outcomes, specific subskills and
critical elements
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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1.
2.
3.
4.
5.
6.
7.
8.
Assessment and Intervention
Communication
Critical Thinking
Human Caring and relationship skills
Management Skills
Leadership Skills
Teaching Skills
Knowledge Integration Skills
Lenburg, Carrie B. The Framework, concepts and methods of the competency outcomes and
performance assessment (COPA) model. © 1999 Online Journal of Issues in Nursing. Sept. 30,
1999 http://nursingworld.org/ojin/topic10/tpc10_2.htm
 Statement of performance expectation
 What does a nurse do?
 What is most important?
 Tasks vs. Phronesis
 Procedures vs. Critical Thinking
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 What performance outcomes do you
see in the workplace that give evidence
of competence in selected core skill?
 Action based statement
 Start sentence with an action verb –
highest level action verb feasible
 KISS principle
© 2003 - 2008 Vermont Organization of
Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
 What is most important?
 Tasks vs. Phronesis
 Procedures vs. Critical Thinking
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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7/17/2015
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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• Prioritizes concepts over cases
• Shifts the focus away from orientation to
the “minutia of nursing”
• Provides the structural foundation for
competency development & assessment
• Uses Performance Outcomes for
validation of competence in clinical
practice
[email protected]
www.vnip.org
© 2001 – 2007 Vermont Nurses In Partnership, Inc.
 Causes us to look beyond the tasks and
procedures of nursing work
 Considers critical thinking skills in
measurable, observable terms
 Includes specific performance
outcomes for teaching, leadership,
human caring relationships,
management, & knowledge integration.
[email protected]
www.vnip.org
© 2001 – 2007 Vermont Nurses In Partnership, Inc.
 Structural foundation for practice-based
competency development & assessment
 Performance Outcomes for both
development and validation of competence
in clinical practice
 Clearly defines expectations for
clinical performance
[email protected]
www.vnip.org
© 2001 – 2007 Vermont Nurses In Partnership, Inc.
 Identify and explore resources
 Recognize limits of own capability
 Seek help/assistance/information
 Assessment of patient & situation
 Collect appropriate data
 What to do with the data?
 Anticipates potential issues and is
prepared to address them
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 Relationship-based caring
 Nurture and support
 Analyze, Evaluate, Synthesis
 Assessment
 Evaluation
 Planning
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 Communication
 Interpersonal skills
 How to provide experiential learning
while protecting safety
 Teaching how to teach, how to
foster critical thinking development
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 What do you want them to be able
to do?
 How much if this is inherent
knowledge?
 What are you having problems with?
 How much of this requires further
instruction in ‘how to do it’?
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 Performance expectations
 Instructional strategies
 Concrete Critical Thinking
Development
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Precepting takes time
 Protocols required to establish
where/how time will be designated
 Core instruction - complete instruction,
complete preparation for the role
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•
•
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
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 Instruction in the clinical setting
 Differentiating between
performance outcomes and
instructional strategies
 Determining behaviors that foster
Critical Thinking development
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Susan A. Boyer, RN, M.Ed. VNIP, Inc
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 Rather than instructor-driven
VT Nurses In Partnership, Inc
www.vnip.org
[email protected]
39

Novice

Advanced beginner

Competent

Proficient

Expert
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Novice (0)
seeks rules and recipes to guide action
Advanced
beginner
Competence
seeks strategic and contextual knowledge;
begins to know when rules can be broken
(4)
able to monitor own performance and make
conscious choices about what to do
Proficiency
increased use of intuition and tacit knowledge;
'reads' the learning situation easily, sees its
events as connected and explicable
Expert (9)
characterized by fluency and automaticity; fully
adapted to, and in control of, the situation
Framework, Berliner (1988); Years experience data from James Leach (1996)
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•
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
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Performance Scoring

Identified Limitation (Novice)

Capable (Advanced Beginner)

Performs Independently (Competent)

Proficient

Expert
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1 – Identified Limitation
requires direct guidance
& support, little or no
experience with skill
BENNER’S
Novice - Inflexible, rule-based.
Little or no background
understanding
2 – Capable - familiar with Advanced Beginner – start to
skill/equipment, but may
need assistance, seeks
help when unfamiliar
with process/skill
use and make sense of
situational elements &
depend on the context.
Temporal focus is immediate
& present
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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
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.
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 What supports development and
transition along these levels of
capability?
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 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
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 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?
48