Master Critical Thinking in Critical Care Precepting
Table of Contents
- Introduction
- Roles of a Preceptor
- The Precepting Model in Critical Care
- The Benner Novice to Expert Continuum
- The Tiered Skills Acquisition Model
- The Phases of Precepting: Married State
- Phase 1: Side by Side
- Phase 2: Shadowing
- Phase 3: Frontline
- Phase 4: Competent State
- The Honeymoon-Shock-Recovery-Resolution Cycle
- Honeymoon Phase
- Shock Phase
- Recovery Phase
- Resolution Phase
- Building Critical Thinking Skills
- Key Questions for Critical Thinking
- Scripting Tools for Critical Conversations
- The Legal Lens of Nursing Practice
- The Oregon Nurse Practice Act
- Scope and Practice Standards
- Organizational Policies
- Competency and Nursing Practice
- The Nursing Process in Precepting
- Assessment
- Nursing Diagnosis
- Planning
- Implementation
- Evaluation
- Conclusion
Article
Introduction
Welcome to our virtual class session on precepting and critical care! In this session, we will be discussing the roles of a preceptor and diving into the intricacies of precepting in the critical care setting. We will explore the Benner Novice to Expert Continuum and the Tiered Skills Acquisition Model. Additionally, we will discuss the different phases of precepting, the Honeymoon-Shock-Recovery-Resolution cycle, and the importance of building critical thinking skills. Finally, we will touch on the legal aspects of nursing practice and the application of the nursing process in precepting.
Roles of a Preceptor
As a preceptor, You have a multitude of roles to fulfill. You are not just a clinician, but also a role model, leader, communicator, socializer, educator, evaluator, and protector. It is essential to understand and embrace these various roles to provide effective precepting. The preceptor model we follow in critical care at Kaiser Sunnyside emphasizes the Benner Novice to Expert Continuum, recognizing that growth and progression are continuous processes. It is also crucial to address any barriers or gaps in knowledge that may hinder the learning process. By assuming good intent and providing generous assumptions, you can Create a safe and supportive environment for your intern.
The Precepting Model in Critical Care
In critical care, we utilize the tiered skills acquisition model to guide interns through the Journey from novice to expert. This model aims to promote progression and independence by the time interns reach the competent stage. The process involves moving interns through different phases, starting with being side by side with the preceptor, then shadowing, and finally taking a more prominent role on the frontline. The goal is to provide the appropriate level of experience and support to help interns develop necessary skills and confidence. By gradually increasing autonomy and responsibility, we prepare them to become competent practitioners in their own right.
The Benner Novice to Expert Continuum
The Benner Novice to Expert Continuum is a framework that recognizes the progression of nurses from novice beginners to expert practitioners. It takes into account the importance of experience, knowledge, and critical thinking skills in the development of nursing expertise. As a preceptor, it is crucial to consider where your intern falls on this continuum and tailor your approach accordingly. Understanding their level of knowledge and experience will help you provide the appropriate guidance and support needed for their growth and development.
The Tiered Skills Acquisition Model
The tiered skills acquisition model is a structured approach to precepting that focuses on developing specific skills and competencies. It involves moving interns through different phases, each providing increased responsibility and autonomy. Starting with being side by side with the preceptor, interns progress to shadowing, then taking a more prominent role on the frontline, and finally reaching the competent state. This model allows interns to gain experience and gradually develop the necessary skills to become independent practitioners. It is important to continuously assess interns' readiness and provide support accordingly to facilitate their growth along the continuum.
The Phases of Precepting: Married State
The married state is a concept that represents the close collaboration and partnership between the preceptor and intern. It symbolizes the hands-on approach to teaching and learning that takes place during the early stages of precepting. In this phase, the preceptor and intern work side by side, sharing knowledge and demonstrating skills. It is an opportunity to build a strong foundation and establish a supportive relationship. The primary goal is to provide the intern with a solid understanding of the clinical practice and help them develop the necessary skills to progress further.
Phase 1: Side by Side
During the side by side phase, the preceptor and intern engage in hands-on teaching and learning. The preceptor demonstrates techniques, explains procedures, and guides the intern through various aspects of patient care. They work collaboratively, sharing knowledge and expertise. This phase helps the intern gain confidence and develop a solid foundation in clinical practice.
Phase 2: Shadowing
In the shadowing phase, the intern takes a more observational role while the preceptor conducts patient care activities. The intern closely observes the preceptor's actions, focusing on technique, decision-making, and critical thinking. This phase allows the intern to gain a deeper understanding of the preceptor's role and responsibilities.
Phase 3: Frontline
The frontline phase marks a shift in the intern's responsibilities, with the preceptor taking a supportive role. The intern takes the lead in patient care activities, with the preceptor available for guidance and assistance as needed. This phase allows the intern to Apply their knowledge and skills while gaining confidence and independence.
Phase 4: Competent State
The competent state is the ultimate goal of precepting. At this stage, the intern has developed the necessary skills, knowledge, and critical thinking abilities to practice independently. The preceptor's role transitions from active supervision to occasional guidance and support. The intern is equipped to handle patient care responsibilities with minimal assistance, demonstrating competence and confidence.
The Honeymoon-Shock-Recovery-Resolution Cycle
The Honeymoon-Shock-Recovery-Resolution cycle is a common experience for interns during their precepting journey. It encompasses the emotional and psychological ups and downs that interns may encounter as they navigate new challenges and responsibilities. Understanding this cycle can help preceptors provide appropriate support during each phase.
Honeymoon Phase
The honeymoon phase is characterized by excitement, enthusiasm, and a Sense of newness. Interns may feel energized and eager to learn and participate in patient care activities. As a preceptor, it is essential to Channel this enthusiasm and provide a positive learning environment.
Shock Phase
The shock phase often follows the honeymoon phase and is marked by feelings of being overwhelmed, self-doubt, and a sense of being in over their heads. Interns may struggle with the complexity and demands of clinical practice. It is crucial for preceptors to recognize and address these feelings, offering guidance, reassurance, and support.
Recovery Phase
The recovery phase is a transition from shock to renewed confidence and competence. Interns begin to regain their sense of self and develop strategies for managing the challenges they face. Preceptors can help facilitate this recovery by providing constructive feedback, opportunities for reflection, and additional support as needed.
Resolution Phase
The resolution phase signifies the mastery of skills and the overall growth and development of the intern. It is characterized by increased confidence, independence, and a sense of accomplishment. Preceptors can Continue to provide guidance and support during this phase to ensure interns reach their full potential.
Building Critical Thinking Skills
Developing critical thinking skills is essential for nurses, especially in the critical care setting. Effective precepting involves guiding interns in developing these skills. Here are key questions that can help facilitate critical thinking:
- What do you need to know?
- What is the risk for error?
- What is the time constraint?
- How do you prioritize care?
- What factors are influencing your thinking?
These questions prompt interns to consider Relevant information, evaluate risks, manage time effectively, and make informed decisions. By providing opportunities for critical thinking, preceptors can help interns develop these skills and enhance their clinical judgment.
Additionally, scripting tools can be used during critical conversations to guide discussions and Elicit critical thinking. Preceptors can ask open-ended questions, encourage self-reflection, and explore different perspectives. These tools can foster deeper understanding, problem-solving, and development of critical thinking skills.
The Legal Lens of Nursing Practice
Nursing practice is governed by legal and ethical guidelines, and it is crucial for preceptors to be familiar with the legal aspects of their practice. The Oregon Nurse Practice Act sets the foundation for nursing practice in the state. It outlines the scope and practice standards that all licensed nurses must adhere to. Preceptors should familiarize themselves with these standards to ensure they provide appropriate guidance and maintain legal compliance.
Organizational policies also play a significant role in guiding nursing practice. Preceptors should be aware of these policies and ensure interns understand and follow them. This includes policies related to patient care, documentation, medication administration, and professional conduct.
Competency is another essential component of nursing practice. Preceptors should continuously assess interns' competency and provide appropriate support and guidance to ensure safe and effective care. Competency includes both cognitive and technical skills, as well as critical thinking, communication, and professionalism.
By understanding and adhering to the legal requirements of nursing practice, preceptors can ensure the safety and well-being of their patients, as well as promote professional growth and development among interns.
The Nursing Process in Precepting
The nursing process is a systematic approach used by nurses to provide patient-centered care. It consists of five interconnected steps: assessment, nursing diagnosis, planning, implementation, and evaluation. Preceptors can incorporate the nursing process into their precepting practices to guide interns in delivering safe and effective care.
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Assessment: The first step in the nursing process is to assess the patient's condition and Gather relevant information. Preceptors should encourage interns to thoroughly assess patients, including physical, psychological, and social aspects. This assessment helps identify the patient's needs and informs decision-making.
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Nursing Diagnosis: Based on the assessment findings, preceptors and interns can collaboratively identify nursing diagnoses. These diagnoses reflect the human responses to actual or potential health problems. Nursing diagnoses guide the planning and implementation of care.
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Planning: Planning involves setting achievable goals and outlining strategies to meet those goals. Preceptors can help interns develop effective care plans that address the patient's needs and Align with evidence-based practices. Planning also involves considering patients' preferences and values.
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Implementation: Implementation involves putting the care plan into action. Preceptors should guide interns in providing safe and evidence-based care. They can demonstrate and explain procedures, delegate tasks as appropriate, and ensure effective communication and collaboration within the healthcare team.
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Evaluation: Evaluation is the final step of the nursing process. Preceptors should help interns assess the effectiveness of their interventions and determine if the desired outcomes have been achieved. Evaluation involves critical thinking and reflection to identify areas for improvement and guide future care.
By incorporating the nursing process into precepting, preceptors can help interns develop a systematic approach to patient care, enhance critical thinking skills, and promote evidence-based practice.
Conclusion
Precepting in critical care requires a multifaceted approach that encompasses various roles, the progression from novice to expert, and the development of critical thinking skills. By understanding and embracing these concepts, preceptors can create effective learning environments and guide interns toward becoming competent practitioners. It is also crucial to have knowledge of the legal aspects of nursing practice and incorporate the nursing process into precepting. Through continuous support, guidance, and ongoing assessment, preceptors play a vital role in shaping the future of nursing.