Accelerating to Practice: Defining a Competency-Based Curriculum Framework for Nursing Education Part 1.

AIM: This study aims to address the transition-to-practice dilemma for novice nurse, define gaps, and lay a foundation for a curriculum framework. BACKGROUND: The National League for Nursing has challenged and supported nurse educators in developing teaching methodologies that prepare novice nurses for professional practice. Over a decade ago, compelling research fueled a debate that continues today, with nursing education and practice research reporting lack of readiness for practice by novice nurses and the goal of identifying gaps and potential strategies for solutions. METHOD: The Utstein-style meeting strategy consensus approach was used to refine the data gaps reported in the literature. RESULTS: The findings from this work generated a strong foundation for a transition-to-practice curriculum framework. CONCLUSION: The Utstein-style meeting provided for a diverse conversation across multiple perspectives. Participants worked collaboratively in real time to further illuminate and refine the data gaps and inform nursing curricula.

The Feasibility of Accelerating to Practice™ for Senior Baccalaureate Nursing Students' Capstone Experience.

ABSTRACT: With the ongoing debate on transition-to-practice gaps and lack of readiness for practice by novice nurses, curricular enhancements and innovation are imperative. A feasibility study was undertaken to inform and assess the integration of an Accelerating to Practice (A2P) curriculum in an academic context. Data from senior capstone students, faculty, and clinical preceptors provide evidence of the usefulness and applicability of A2P to provide intentional learning outcomes targeted at new graduates' areas of weakness. This experience was aimed at clinical decision-making with psychomotor skill-laden activities deemphasized. A2P scaffolding aided in deeper learning and resulted in improved student learning.

Evidence-Based Debriefing.

Ongoing shifts in the healthcare system require practitioners who possess metacognitive skills to evaluate their decisions and the thinking and rationale guiding those decisions. In an effort to design learning activities that support metacognition in nursing education, undergraduate and graduate faculty, are embracing simulation-based education (SBE) as an effective teaching and learning strategy. SBE includes prebriefing, the simulation scenario, and debriefing, all of which are supported by psychological safety. Prebriefing precedes the entire learning process and is integral to engagement in the simulation and to the effectiveness of the debriefing. Debriefing provides educators with the opportunity to explore and develop those metacognitive skills with learners. In this chapter on evidence-based debriefing, the authors will explore the evidence and theories surrounding best practices in SBE, specifically the prebriefing and debriefing components of the learning experience. The chapter explores the theoretical foundation of SBE and theory-based debriefing; educational best practices of prebriefing as an integral part of an effective debriefing; theory-based debriefing models; research evidence of debriefing outcomes; evaluation of the prebriefing and debriefing process; and finally, provides recommendations on the priorities for further research in debriefing. Within this chapter, the term educator is inclusive of undergraduate, graduate, and professional development nurse educators and reflects the educator role in SBE.

Simulation as a Nursing Education Disrupter.

Simulation as an evidence-based pedagogy began emerging at a time when many constraints were being imposed on clinical experiences for nursing students. As research illuminated the advantages of simulation and standards were developed, educators began to recognize the limitations of the clinical setting, such as the inability to provide experiences in teamwork and delegation, and a focus on tasks. Simulations are crafted to provide an experience that matches content that is being taught in class, and debriefing techniques guide learners in a reflective process that promotes the development of clinical reasoning and judgment. The National Council of State Boards of Nursing study concluded that simulation could be substituted for 50% of clinical hours. Simulation-exposed gaps in the curriculum and its pedagogical principles are now extending to adaptations of its use in the classroom and in clinical postconferences. They are also shaping teacher-student conversations in the office and the hallways. Use of simulation for assessment is beginning to evolve. In a little more than 10 years, it has started a revolution that will continue to have a major impact on all aspects of nursing education in the future.

Creating context for critical thinking in practice: the role of the preceptor.

AIM: This paper is a report of a study to determine the impact of the preceptor coaching component of a reflective contextual learning intervention on novice nurses' critical thinking skills during the first 6 months of their practice. BACKGROUND: The use of preceptors to develop novice nurses' clinical skills has been well documented in the literature. However, there is little literature focused on preceptor involvement to develop novice nurses' critical thinking. METHOD: This small case study was conducted in the United States of America in 2004 with six nurse/preceptor dyads. Stake's qualitative instrumental case study design was used to evaluate the preceptor component of the contextual learning intervention. Stories of preceptor experiences were analyzed using Stake's phases of data analysis (i.e. description, categorical aggregation, establishing patterns, naturalistic generalizations). Specific questions (e.g. nature of coaching used by the preceptor) guided the analysis. Repeating patterns were coded and isolated and later collapsed as the analysis moved forward. FINDINGS: Preceptors use of the contextual learning intervention created a context that stimulated novice nurses' critical thinking. Two main themes describe the novice nurses' critical thinking skills relative to the preceptor coaching: 1) critical thinking as organizing and carrying out tasks; and 2) critical thinking as intentional, reflective thinking. CONCLUSION: Preceptor education should incorporate the following components: understanding the impact of power and anxiety on critical thinking of novice nurses transitioning into practice; creating dialogue that invites questions in a reflective and critical manner; and challenging thinking through sharing of perspectives.

Evaluation of a reflective learning intervention to improve critical thinking in novice nurses.

AIM: This paper reports a study to determine if a reflective contextual learning intervention would improve novice nurses' critical thinking skills during the first 6 months of their practice. BACKGROUND: Nursing research evaluating the development of critical thinking in novice nursing practice is limited. The continual struggle by nurse educators to improve critical thinking demonstrates the need for innovative educational interventions that assist in the development of critical thinking as novice nurses enter into practice. METHOD: This small case study was conducted in the United States of America in 2004 with six student/preceptor dyads. The contextual learning intervention was the case through which the novice nurses' critical thinking were analysed using Stake's phases of data analysis. Specific questions (i.e. novice nurses' use of reflection, context, dialogue, time) guided the analysis. Repeating patterns were coded and isolated and later collapsed/enhanced as the analysis moved forward. FINDINGS: Three main themes describe the novice nurses' development of critical thinking: (1) influence of anxiety and power on critical thinking; putting pieces together; (2) questioning as critical thinking: sequential thinking to contextual thinking; and (3) emergence of the intentional critical thinker. CONCLUSION: Used as a reflective practicum, contextual learning can be a model of clinical learning in nursing education that develops the contextual, reflective nature of critical thinking.