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Practicum Reflection Journal

Erin Kibbey

Week # Date Time Activities # of Hours

1

Monday, Jan. 13, 2014

8:00 am – 12:00 pm Attended simulation operator class 4


1:00 pm – 3:00 pm

Met with preceptor. Discussed practicum plan, as well as Critical Care Internship schedule, learning gaps, plan

for modifications to schedule, and changes needed for internship

2

Thursday, Jan. 16, 2014

11:00 pm – 12:00 pm

Attended meeting with interview committee for Critical Care Internship 1


3:00 pm – 6:00 pm

Observed and participated as a facilitator in Role Transition Class.

Class topics included: moral distress & caring for the dying patient.

3

Week 1 # of Hours 10

Week 1 Summary

The first practicum opportunity I took part in was a simulation operator class. This class

took place in the simulation lab at Munson Medical Center. It was facilitated by a master’s

prepared registered nurse from staff development. Munson’s simulation lab is equipped with

both the SimMan and SimMan 3G. Since I was the only individual in attendance for the class I

was able to get quite a bit of one-on-one time with the manikins and the computers used to run

the simulation scenarios. The main goal of this particular class was for participants to learn how

to operate the high-fidelity manikins and run a simulation utilizing the Laerdal software. Thus, I

was able to learn how to run the SimMan graphic user interface, change parameters on the

SimMan monitors, run the equipment utilized with the manikins, troubleshoot equipment

problems, locate resources that could be used in the scenario, and review the hospitals policy

related to use of the simulation lab.

2

During this week I also met with my preceptor, Patti, and reviewed my practicum plan.

We took a look at the schedule for the new class of interns, which is slated to start March 10.

There were hospital wide changes to hospital orientation for new employees that would have an

impact on the previous set-up for the internship. Thus, we looked at this and discussed ways to

change the schedule and what things needed to be accomplished during the two weeks of

orientation. Patti also brought up several topics of learning needs that she felt (based on

feedback from past interns and preceptors) needed to be highlighted with the next class of

interns.

On Thursday, there was a one hour meeting with the internship interview committee to

review resumes, references, etc. of possible candidates for the critical care internship. There was

representation from each of the critical care units. We briefly discussed the set-up for the

interviews.

Finally, I also attended and participated in my first role transition class that Patti

facilitates. There was a PowerPoint presentation and lecture given by a nurse from the ICU

related to moral distress and caring for the dying patient. The new nurses in attendance at this

class sat at tables with a volunteer facilitator at each of the tables. There were four small groups.

I sat at a table with three other nurses and helped facilitate discussion amongst the group

members on these topics.

Insights/Discoveries/Reflection

I believe the opportunity to learn how to operate high-fidelity manikins in a simulation

lab was a very valuable experience to help prepare me for the role of a nurse educator. During

this class I was able to learn hands-on and actually run through a few scenarios as the operator

with the instructor acting out the scenarios. This provided a realistic opportunity for me to

3

actually use the equipment and perform the duties of the operator. I found the class very

interesting and something I hope to use this semester during other practicum opportunities. I felt

pretty comfortable with the technology, however, I would definitely benefit from continued

practice to help build confidence when running various scenarios. I would also like to run the

simulations with a group of students as opposed to one student so that I could see the

difference(s). I felt the facilitator of this class was very knowledgeable and approachable with

questions and I truly appreciated the opportunity to try all of the equipment out.

Meeting with my preceptor went well. I feel she is excited and pleased to have me

working with her and does not make me feel like a burden. She values my input as a preceptor

of the critical care interns and is certainly welcoming to new ideas. One thing I was curious

about was exactly where she obtained her information about learning needs. She definitely has a

lot of ideas about certain skills, hospital initiatives, and critical thinking information that needs to

be implemented into the next internship but I don’t really understand where she came up with

these ideas or if it is primarily from discussion. I jotted the ideas down and figured we will

definitely be coming back to them.

Meeting with the other members of the interview committee was nice. I made some new

contacts with unit educators and introduced myself. It was interesting to review the internship

candidate’s information and hear briefly about them. I also enjoyed listening to how the

committee members spoke with each other and voiced concerns and recommendations for some

of the candidates that they were familiar with. This was a relaxed, open meeting and I felt

comfortable as part of the group.

The role transition class was bigger than I thought it would be. I felt a little bit

uncomfortable at first because I wasn’t sure whether to sit, stand, or go in the corner. My

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preceptor was there and I briefly spoke with her but she didn’t really direct me as to what I

should do. This was not the first class of the series so she knew the individuals in the class.

Eventually I ended up sitting at a table with three other individuals and the class began. I

thought the nurse from the ICU did a great job with her presentation. The class was engaged and

she did a good job of keeping the right pace with the presentation. At various points she stopped

talking and we would have discussions within our small group at the tables. Patti told me to help

facilitate within the group by actively listening and keeping the topic going by asking additional

questions. Some of the discussions were difficult due to the topic of moral stress and death but

overall, I felt they went well. I was slightly uncomfortable feeling that I was sort of thrown into

a facilitator role but I did get over my uncomfortableness pretty quickly. In hindsight, I think it

would have been beneficial to sort of guide me beforehand with what exactly Patti wanted me to

do and accomplish during these times of facilitation. On the other hand, I also know that part of

my apprehension with teaching is the thought of having the spotlight on me, so to speak. I am

not very comfortable in large groups and having to talk. However, I am definitely hoping that

with time this uncomfortable feeling with begin diminishing.

Analysis

The use of simulation technology is rapidly expanding and familiarity with this

technology is important for nurse educators (Jeffries & Clochesy, 2012). This type of learning

approach can be very beneficial for nurses learning critical care due to the acutely ill status of the

patients they are preparing to care for throughout the internship. Learners must be ready for the

complexity of patients and the fast pace of the critical care units, as well as be able to solve

problems and make decisions in order to achieve desired outcomes (Jeffries & Clochesy, 2012).

Now that I am trained to operate the simulation manikins it will be possible to incorporate more

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simulation into the internship curriculum to provide an interactive, practice-based instructional

strategy. In addition to simulation use continuing to be emphasized in nursing education,

according to Shellenbarger and Edwards (2012), simulation activities can benefit graduate nurse

educator students as well. Accordingly, simulation activities can be a useful way for novice

nurse educators to create scenarios for simulation so they can practice the skills of planning,

implementing, and evaluating teaching and learning skills. Thus, not only was it beneficial to

learn the use of this technology for future use but the process of learning it and practicing using it

can help me gain experience in several key areas as a nurse educator.

Since the role transition class was my first attempt at playing the role of facilitator in this

practicum, my first and main focus was on creating the right tone for students to feel comfortable

sharing, especially with the difficult topics that were presented in the class. According to the

National League for Nursing (NLN, 2012), facilitation of learning can be accomplished by

creating an environment conducive for students to learn the desired outcomes. In addition, I

knew it was also important, as noted by the NLN (2012), to display interest and respect for the

learners. I shared stories that demonstrated patience, caring, and integrity.

Week # Date Time Activities # of Hours2

Sunday, Jan. 19, 2014

3:00 pm – 5:00 pm

Read information on NPDS standards of practice, NPD nursing review and

resource manual, and literature related to residency/internship programs.

Researched educational resources that could potentially be utilized in

internship program. Emailed preceptor information and provided some ideas for

what kinds of activities I could help with for the week.

2


12:00 pm – 1:00 pm

Met with preceptor. Discussed plan for the week. Gathered BKAT results to

take home and compile for evaluation of content needs for critical care internship.

Discussed other evaluation methods

1

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used and looked at examples. Formulated a plan to look at the

additional evaluation tools Wednesday. Discussed setting up a physical

assessment simulation for the interns during their second week of orientation.

Brainstormed ideas for this.


2:30 pm – 6:00 pm

Compiled 8 critical classes worth of BKAT results into an Excel spreadsheet.

Looked at pre and post test scores, calculated % change.

3.5

Wednesday, Jan. 22, 2014

11:15 am – 12:00 pm

Met with preceptor to obtain more evaluations from internship program. Discussed data from results that were

compiled so far. Discussed plans/goals for the rest of the week since we won’t

be meeting again until next week.

0.75


12:00 pm – 4:15 pm Attended simulation facilitator class 4.25


11:30 pm – 4:30

Continued developing Excel spreadsheet with group 9 added. Started additional spreadsheet using BKAT score sheet to compile results of critical care content areas that orientees missed from pre &

post-tests.

5

Saturday, Jan. 25, 2014

6:00 pm – 9:30 pm

Continued compiling results of critical care content areas missed from pre and

post BKAT scores.3.5


Week 2 Summary

This week started with a review of the literature for nursing professional development

specialists. I also emailed my preceptor to maintain and continue a plan for the next few weeks

of practicum activities. Upon meeting with Patti again on Monday, we began a focus on looking

at evaluation methods used for the critical care internship. Patti gave me eight classes worth of

results from the Basic Knowledge Assessment Test for Critical Care (BKAT). This test was

given at the start of the internship program and at the end of the internship. They are 100

question tests for the BKAT-7 and 90 question tests for the BKAT -8 (the most recent test). The

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results of how interns had improved and what content areas they were still having difficulty with

were never placed into any kind of spreadsheet and evaluated. I took the tests home and began

inputting the data into Excel to better evaluate the tests. I was able to calculate the percent

change from the pre-test and post-test results. Once I was done calculating the percent change, I

next began looking at each individual question on the test and what content area the question

pertained to. In scoring the BKAT’s there is an answer sheet and score sheet that tells what

content area the question pertains to (such as emergency situations, EKG interpretation,

monitoring of lines, ventilators, etc.). In meeting with Patti again later in the week, I also

obtained multiple other evaluations from the internship that she allowed me to take home and

review.

The other main practicum opportunity this week was attending the simulation facilitator

class. Again, this class took place in the simulation lab at Munson. The facilitator was the same

as for the operator class. I was in the class with one other individual, the educator of the unit I

currently work. This class had a similar set-up as the operator class in that we first looked at a

PowerPoint related to the facilitation of simulation technology as an educational activity. After

the presentation we practiced acting as a facilitator and as an operator and went through a couple

of simulation scenarios for hands-on practice. Next, we discussed the elements of debriefing and

practiced debriefing based on the simulation scenarios we played out earlier. Finally, we looked

at the process of evaluating facilitator effectiveness and self-evaluation.


I started out this week nervous that I was not going to get enough hours and that I was not

sure about exactly what I should do all week. I was anxious to get past the point of just talking

about our plan and beginning to really tackle some projects, so to speak. The goal of looking at

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evaluation this week, however, resulted in giving me a ton of materials to examine. I was

surprised and overwhelmed by the amount of evaluation data pertaining to the internship that had

been collected over the years. I was also amazed at the lack of compilation of the data. The raw

evaluations were just in a filing cabinet but had never been placed into a usable form. I have to

say that I do not really understand the point of all the evaluations if they are not put into a form

where the data is interpreted in a meaningful way. Thus, I embarked on my journey of

compiling the data. This process definitely took me awhile, although I am pretty fast with

computers and Excel. I also read over some of the other internship evaluations. Some of the

evaluations were filled out by the unit educators, some my preceptors, and some by the interns

themselves. Again, I felt some of the data was useful but it was quite time consuming to read

through the material with the way the evaluations were designed. Compiling the content areas

was also a little more time consuming than I thought it would be, but I felt like it would be a

good starting point for my clinical project of implementation of didactic lessons based on

believed learning gaps. I believe this information will be useful for the future too, if the database

could continue to be updated.

The simulation facilitator class was another great practicum experience. I really enjoyed

and found it useful in putting the information learned from the beginning of the class into action

when assigned to act as a facilitator. Since I had already taken the operator class, I was also able

to run one of the simulations as an operator while the other participant acted out the facilitator

role and the instructor acted out the scenario. I loved the individualized attention in the class and

the chance to practice both roles. I also found the actual chance to debrief and discuss effective

ways to debrief very useful.

9

Analysis

Nurse educators must use a variety of strategies to assess and evaluate learning (NLN,

2012). This week’s activities were highly focused on this NLN competency. The main

assessment tool identified and utilized during this week was the BKAT-7 and BKAT-8 that were

completed by the interns before and after the internship. According to Toth (2008), the author of

the BKAT-8, the validity of this test was ascertained by a panel of experts. In addition, the

internal consistency reliability was alpha = 0.88, measured on 48 critical care nurses from five

different states. Toth (2008) also noted that the BKAT can be useful for identifying needed

content and as a measure of learning, however, it is only one measure of basic knowledge in

critical care and should not be used for hiring or firing purposes. Analysis of the compiled data

from the BKAT’s did show that there was average of a 19.3% increase in number of correct

answers on the post BKAT test compared to the pre BKAT test given before the internship. In

addition, scores on the pre-test averaged less than 68% and just over 80% on the post-test. While

the increase in number of correct answers does indicate good growth, according to Toth (2008),

it is expected that after orientation nurses achieve an average score of 84%. I believe this

indicates that there is definitely room for improvement and supports the need to look more

closely at the specific questions on the BKAT to see if there is specific content being missed.

In taking part in the debriefing portion of the facilitator class, we were taught to use the

debriefing assessment for simulation in healthcare (DASH) tool as created by the Center for

Medical Simulation (2013). The tool is based on evidence and theory related to learning and

change through experience. It evaluates the strategies used to facilitate debriefings such as

creating an environment conducive to learning, provoking engaging discussion, and

organization. Additional references including the International Nursing Association for Clinical

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Simulation and Learning (INACSL) simulation standards and sources from the NLN were also

provided by the Munson staff educator for use in learning and practicing facilitation and

debriefing techniques.

Week # Date Time Activities # of Hours

3


9:00 am – 12:00 pm Prepared for facilitating at skills lab 3


8:30 am – 12:00 pm

Facilitated at critical care skills lab station pertaining to the analysis of

arterial blood gases.3.5


12:00 pm – 4:30 pm

Participated on interview committee for new critical care internship candidates 4.5


10:30 am – 3:30 pm

Day 2 of interviews for new critical care internship candidates. Chose candidates

after interviews were completed.5

Saturday, Feb. 1, 2014

9:45 am – 11:15,

1:00 pm – 3:30 pm

Finished compiling results of critical care content areas missed from pre and

post BKAT scores.4


Cumulative Total Wks. 1-3 50

Week 3 Summary

The third week of this practicum started with preparing for being a facilitator for one of

the critical care skills labs. The skills labs are small group sessions with various stations set-up

for critical care interns and nurses that have recently trained to critical care. They are held

usually once a month and are separated by body systems. This particular lab was the pulmonary

skills lab. My assigned station was on arterial blood gas (ABG) analysis. I had obtained some

materials from my unit educator last week to help prepare for this lab. Per an email I received

from one of the staff educators, each group was going to be at each station for about 30 minutes.

Thus I spent several hours reviewing the computer based education that the newly trained critical

care nurses get before attending the lab session. I also made copies from the Pass CCRN book of

several questions related to ABG’s. I also made an outline of learning objectives, important

11

points, and pertinent information. I examined some case studies and refreshed my memory on

some of the more difficult analysis interpretations. The next morning, I facilitated the ABG

station at the skills lab to small groups over the course of three and a half hours.

The other two main days of week three were spent participating on the interview

committee for the critical care internship program. There were a total of eight members on this

committee, including me. There were a total of nine candidates slated for only four spots within

the internship program. Interviews ran around 30 minutes a piece with approximately fifteen

minutes in between each candidate to discuss. Each of the candidates had basically the same

questions asked to them. At the end of the two days the committee spent time discussing the

candidates and who their top picks were. The committee came to an agreement and the four

interns were selected, along with one alternate.

Finally, the last of the BKAT results were compiled to round out the week’s activities.

Content areas were tabulated across each of the individuals. In total, I tabulated 26 students that

took the BKAT-8. All 90 questions were examined on both the pre-test and post-test, so this was

quite a bit of data to record.


I felt the skills lab went smoothly. I was nervous at first, once again, related to speaking

in front of a group. However, I did know most of the learners and this made me much more

comfortable. I tried to make the session engaging and useful for actual practice, as I believe this

is the goal of the lab sessions. I also believe that I showed enthusiasm and interest in and respect

for the learners. Once I discussed some of the background information related to analysis I had

the learners individually go through some of the practice examples I had passed out and made

copies of. I felt this worked well by giving them an opportunity to actually practice the

12

information. Then we reviewed the answers and discussed some of the questions that were more

difficult. In an email from the staff educator that oversaw the lab session she remarked that the

evaluations were some of the best she has had in some time. She felt this was due to the limited

wait time between stations and the flexibility of some of the facilitators in running their station in

between some of the longer stations. She also remarked that there were especially good reviews

over the ABG and ventilator stations. I felt excited that there was some positive feedback related

to the session and my station in particular. The educator also noted that she was still tallying up

all of the evaluations and would give us all of the feedback once she had it completed. A couple

of the learners also remarked that they found my station helpful and they liked that I actually had

them doing things as many of them had worked a full shift that night and it helped keep them

focused.

As for the interviews, I really enjoyed this process. I felt it was a good experience to be

part of this committee and seeing not only how the interview process worked for the internship

but also what type of knowledge and experience the candidates presented with. Some of the

interview questions were scenario questions and it was interesting to hear what the candidates

had to say and where their thought process was as new nurses. I also noted a vast difference in

knowledge between the candidates from different schools and clinical experiences. Again, I felt

a part of the group and was happy to feel that my opinion mattered throughout this process.

Somewhat surprisingly, there was 100% agreement with the four candidates chosen and there

was only some minor discussion related to the choosing of an alternate.

Analysis

After compiling some resources for use in preparation for the skills lab, my first step was

to create learning objectives. According to Billings and Halstead (2009), it is important that

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content is considered a value to the student and essential to the core curriculum. Thus, in order

to determine some of the most important content areas to be included in the objectives, I looked

at the Essentials of Critical Care Orientation (ECCO) curriculum on ABG analysis. The ECCO

curriculum is the computer based training that the critical care interns and new nurses training to

critical care at Munson currently use. Once the objectives for the lesson plan were created, the

next step in planning my skills session was to create an outline to organize the content.

According to Saunders (2003), an outline forces the educator to consider the organization and

flow of ideas for a class session; outlines also flow directly from the objectives. After broadly

reviewing the literature and resources I had gathered related to ABG’s, I was able to construct an

outline that flowed from the objectives and considered the essential content and how it all fit

together. The next concern in developing the lab session was deciding the teaching strategies

that would be implemented to facilitate learning of the stated objectives. One important

consideration is that one learning style may not be suited to every student. Therefore, a variety

of teaching strategies are usually needed to provide support to various learning styles (Billings &

Halstead, 2009). In addition, although a student may have a preferred learning method, exposure

to multiple teaching methods can challenge the student to think outside of the box (2009). For

this session, teaching strategies were developed to promote the desired learning objectives whilst

considering the content, my teaching abilities, and the learners themselves. Thus, I decided to

use a mixture of informal lecture, handouts, practice questions, and case scenarios to elicit

feedback and active participation throughout the learning session.

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References

Billings, D., & Halstead, J. (2009). Teaching in nursing: A guide for faculty (3rd ed.).

Philadelphia, PA: W. B. Saunders.

Center for Medical Simulation. (2013). Debriefing assessment for simulation in healthcare

(DASH): Rater’s handbook. Retrieved from

http://www.harvardmedsim.org/_media/DASH.handbook.2010.Final.Rev.2.pdf

Jeffries, P. R., & Clochesy, J. M. (2012). Clinical simulations: An experiential, student-centered

pedagogical approach. In D. Billings & J. Halstead (Eds.), Teaching in nursing: A guide

for faculty (4th ed.). (pp. 352-368). St. Louis, MO: Elsevier Saunders.

National League for Nursing [NLN]. (2012). The scope of practice for academic nurse

educators 2012 revision. NY: Author.

Saunders, R. (2003). Constructing a lesson plan. Journal for Nurses in Staff Development, 19(2),

70-80.

Shellenbarger, T. & Edwards, T. (2012). Nurse educator simulation: Preparing faculty for

clinical nurse educator roles. Clinical Simulation in Nursing, 8(6), 249-255.

doi:10.1016/j.ecns.2010.12.006

Toth, J. (2008). The basic knowledge assessment tool, version eight (BKAT-8): For adult critical

care nursing. Retrieved from http://www.bkat-toth.org/BKAT-8.html.

START OF JOURNAL 2

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Week #

Date Time Activities # of Hours

4

Wednesday, February 5,

2014

8:30 am – 11:30 am Attended the monthly Nurse Practice Council meeting with preceptor 3


2014

12:00 pm – 4:00 pm

Worked with preceptor on various small projects, discussed my practicum progress/goals, plans for the week, and internship planning.

Preceptor also located the BKAT tests for internship classes 10-12. Began compiling those results into the ongoing spreadsheet.

4

Thursday, February 6,

2014

10:00 am – 3:00 pm

Stopped in library and picked up a couple books on nursing physical assessment/critical care nursing for simulation lab planning. Worked with preceptor. Began teaching plan for simulation that will take place

the second week of internship. Emailed Sim lab coordinator to schedule lab time. Discussed my responsibilities and scheduling with

my preceptor during the 1st four weeks of internship.

5


2014

3:45 pm – 5:15 pm

Researched evaluation of simulations and developing a simulation on physical assessment. 1.5

Friday, February 7,

2014

10:00 am – 12:15 pm,

12:30 pm – 5:00 pm, 7:45 pm– 8:00 pm

Continued teaching plan for physical assessment simulation lab. Utilized Munson’s planning sheet sent to me by the sim lab coordinator. Reviewed email back from sim lab coordinator confirming lab time. Re-

emailed with additional questions and plan for moving forward.

7

Week 4 # of Hours 20.5

Cumulative Total Wks. 1-4 70.5

Week 4 Summary

I started this week by attending the Nurse Practice Council meeting with my preceptor. This is a

meeting held monthly and is attended by representatives from the various nursing units and is chaired by

the director of nursing. The council discussed various items related to nursing practice, education, and

operations. During this meeting, a proposal for modifications to the Professional Practice Model was

brought up by the director of nursing. The proposal was discussed and a subcommittee was formed in

order to further review and incorporate the changes to the model. My preceptor volunteered both of us to

help serve on this committee.

This week I also was able to get more BKAT results from my preceptor to being tabulating into my

ongoing spreadsheet. I also began working on our idea from week two about adding a physical

assessment simulation lab to the beginning of the critical care orientation. My preceptor and I decided this

would be one of my teaching lessons that I would plan and deliver to work towards my clinical project goal

of implementing at least two lessons into the existing educational materials. Once my preceptor and I

16

established a time and date that we felt would work well with orientation, I facilitated getting the simulation

lab secured for this learning activity. I also began gathering materials to help me in not only designing the

simulation activity, but also in evaluation of the activity and our learning outcomes. I utilized a teaching

outline that the staff development and simulation coordinator sent to me, in order to begin writing my

teaching plan for the simulation.


Overall, I felt quite productive this week. To start, I enjoyed attending the Nurse Practice Council

meeting and hearing more about was going on organizationally. Although I had not included roles and

activities such as this in my practicum planning guide, I did hope that I would have opportunities to gain

competency in the change agent and leadership role for the nursing professional development specialist. I

believe attending this meeting and volunteering to serve on the subcommittee for modifications to the

professional practice model has been beneficial in gaining competency in these roles. It was also really

beneficial to gain a better perspective of how the organization functions and how different projects have an

impact throughout the organization. I liked being able to meet new people, especially those names that I

recognized, and see how they performed their role. Finally, I also thought it was important to see the way

communication flowed in the meeting, how the meeting was facilitated, and how people’s opinions were

valued. For example, one important item that was on the agenda for the meeting was about determining

informational technology priorities for the next fiscal year. Various people discussed their feelings on the

topic and the committee came to the conclusion that the focus would be on not bringing any new projects

forward but just focusing on the issues currently being tackled. I felt this was an important decision

because requests for information technology changes has been taking quite a bit of time and instead of

adding more to that issue it was decided to continue chipping away at the issues the organization already

has.

The rest of the week I was able to work on my clinical project and developing a simulation on

performing a physical assessment. I found the planning outline the simulation coordinator sent me to be

17

very useful. Although beginning designing this lesson did take some time I was able to get a good portion

of this completed and am feeling confident that I will be able to tackle the rest of the planning for this next

week. I was able to come up with learning outcomes, learning objectives, and a pretty good outline as to

how the simulation would run. I was excited about being able to try to create the learning plan on my own,

but I was also a bit nervous about knowing exactly what my preceptor’s intentions and desires were for the

learning. I found that working on some of the teaching plan in my preceptor’s office while she was working

on other items worked well, so that I could bounce questions off of her as I was formulating my plan. Once

I got a good start on knowing the direction for the simulation, I was able to spend a good chunk of time on

the outline and putting everything together.

Analysis

The change agent and leadership roles are important pieces to becoming a competent nurse

educator and nursing professional development specialist (Brunt, 2007; National League for Nursing (NLN),

2012); thus, I believe it is valuable use of my practicum time to attend the Nurse Practice Council meeting

and any future meetings with my preceptor. According to the American Nurses Association and National

Nursing Staff Development Organization (ANA & NNSDO, 2010), providing support and direction in fulfilling

the goals of an organization, using effective communication skills, and influencing change processes are

important elements of practice related to the leader and communicator roles of the nursing professional

development specialist. These elements were observed throughout the council meeting.

In looking at the development of a teaching lesson for simulation, I first focused on the objectives,

outcomes, and competencies of what we wanted the interns to be able to accomplish as a result of the

learning activity. According to Billings (2012), each lesson should state the purpose, outcomes,

assignments, learning activities, and evaluation being used. Since our identified learning gap was

performing a physical assessment on a critically ill, hospitalized patient, our learning outcomes focused on

improving clinical performance and self-confidence. The introduction of the critically ill patient in the

simulation lab, early in the orientation period, was felt to be a safe and less threatening way of learning how

18

to perform a complete physical assessment and become familiar with some of the equipment that would be

seen throughout the orientation period. According to Jeffies and Clochesy (2012), simulation can be a safe

environment conducive to learning skills that require practicing a number of times. The learning outcomes

and placement of this particular simulation learning activity at the beginning of critical care orientation is

also in line with the idea that learning activities should build from level to level and be threaded throughout

the course as they fit with the program outcomes (Billings, 2012). Moreover, the simulation activity could

assist my preceptor and me with a more effective method of measuring the skill and level of comfort the

interns possess before allowing them on the critical care units (Billings, 2012).

Week # Date Time Activities # of

Hours

5

Monday, February 10,

2014

8:30 am – 11:30 am Worked on physical assessment simulation learning outline 3


2014

10:30 am – 4:00 pm

Met with preceptor, discussed plans for the week and where she/we were at with various projects and continued internship planning. Went to two of CC units to see when the last class of interns were signed up for annual

discussions. Saw and talked with one of the interns briefly. Went to a meeting with preceptor related to scheduling system issues and the

internship.

5.5


2014

10:00 am – 3:00 pm

Attended 2 hour nurse manager/operations council meeting. Attended 1 hour peer review meeting for my preceptor and two educators for other hospital units. Looked at and discussed outlines that the interns had

made for their upcoming presentations they will facilitate once they have completed the internship. Preceptor emailed a couple of the interns that still needed additions/modifications with their outline so that we could set

up a time to meet.

5

Friday, February 14,

2014

9:00 am – 12:00 pm,

12:30 pm – 7:00 pm

Made modifications to simulation teaching plan from preceptor suggestions. Emailed plan to Sim lab coordinator. Worked on checklist for outcomes of simulation. Read from library books related to performance of an advanced physical assessment. Read literature about designing

simulations.

9.5



Week 5 Summary

At the start of this week, I continued with the design of the physical assessment simulation and

completing the teaching outline so that I could have it reviewed by my preceptor and then send it to the

simulation coordinator so she could build the scenario into the simulation software. On Wednesday, I was

able to spend a good portion of the day with my preceptor doing various activities as listed above. One of

19

the activities involved meeting with someone from human resources, someone from the information

technology department, the manager of another one of the critical care units, and the manager from the

critical care pool. Since the organization is moving to a system of electronic scheduling there are several

issues related to the critical care internship and how they are showing up in the system and how they are

able to function with this software. The meeting was set to help see the issues everyone was having and

develop a plan to fix the issues.

I was also able to attend a couple of other meetings this week including the nursing operational

council meeting and a peer review meeting for my preceptor and two other hospital educators. The

operational meeting include both nursing managers and nurse educators of the units. The meeting was

chaired once again by the director of nursing and several topics were discussed including the budget for

the next fiscal year, the addition of a central transport unit, opening of an online patient portal, and changes

to the shared governance model. The peer review meeting took place in my preceptor’s office and was in

preparation for annual discussions and evaluating where they were at with their professional practice. The

rest of the week involved reviewing of case presentation outlines from the last group of critical care interns,

working on and reviewing my simulation outline with my preceptor, and developing a competency checklist

and evaluation strategies for the simulation activity.


This week seemed like it flew by. I also felt like it went smoothly and I was glad to spend some

quality time with my preceptor see her function in various roles. I learned a lot about the complications of

technology within an organization and the various forces that really come into play in the functioning of a

hospital educator. I am realizing that it often takes a great deal of time on a daily basis just to get through

email correspondences. It was also helpful to attend the management meeting and see how this council

functions. One thing that I found particularly important to hear from this meeting was the cutting of meeting

20

and education times on units. This really drove home the budgetary and time restraints that come into play

when designing educational activities for staff.

I found the peer review meeting particularly interesting. One thing I noticed is that the other two

educators do not have master’s degrees and that in their review of their competencies related to their

educator role they did not always understand how to evaluate themselves. My preceptor and I actually

talked about this after the meeting was over. She also told me that once she took an educator position a lot

of the job did involve educating herself with the role as there was really no formal orientation. Even though

my preceptor has a master’s degree it was for nurse practitioner so she also noted her own difficulty with

knowing about learning outcomes and how to measure them, creating a curriculum, and evaluation. In

some ways, this knowledge deficit has made it more difficult for me as these were some of the main things I

wanted to focus on in my practicum. However, my preceptor is very open to new ideas, has a lot of

experience, and I think (and hope) we are helping each other muddle through these things with the goal of

improving the internship program.

As for the simulation planning, I have found this to be a great learning experience. I am happy to

have a project of my own that will hopefully prove to be beneficial to the next class of interns. In developing

the simulation teaching outline further, I utilized a lot of resources online and information provided to me

during my simulation training. Looking at other examples of simulation planning was also helpful for ideas

and information about what I wanted to include in evaluating the learning outcomes of clinical performance

and self-confidence.

Analysis

Participating in peer review can be seen as contributing to the competency standard of

professional practice evaluation for the nursing professional development specialist. According to the ANA

and NNSDO (2010), providing peers with feedback regarding their role and interacting with peers to

enhance practice and role performance are examples of measurement criteria contributing to the standard

of collegiality. I can see how this participation in peer review was especially beneficial for the educators

21

that had not had master’s degree education in relation to these standards. During the meeting, the

educators also decided to meet regularly throughout the year with a goal of helping preceptors. They

decided to have a goal for their next meeting of putting together some resources for preceptors. They felt

that preceptors have had additional burdens placed on them and they were interested in providing them

with convenient tools and resources to help alleviate some of their burden. This goal could also be seen as

contributing to the standard of collegiality and the contribution to a supportive and safe work environment

that fosters mutual respect (ANA & NNSDO, 2010).

In looking at the nursing professional development standard of resource utilization, the NPD

specialist must be able to consider factors related to cost of activities (ANA & NNSDO, 2010). Attending an

operational meeting that discusses fiscal year budgets and educational allocations is an important activity

towards being able to meet this standard. In order to function within the educational environment as a

nurse educator, one must also be aware of the various forces that impact their role (NLN, 2012). Taking

part in various meetings and understanding more about the organizational and national health care climate

that the educator must function in are a large part of being able to function within the educational

environment.


Hours

6


2014

11:00 am –12:00 pm,12:00 pm – 1:30 pm

Attended a subcommittee meeting for PPM. Performed researched related to standards of care with physical

assessment. 2.5


2014

9:00 am – 11:00 am, 11:00 am – 12:30 pm,

12:30 pm – 1:30 pm, 1:30 pm – 3:15 pm

Met with preceptor, discussed plans for the week and where she/we were at with various projects. Gave hospital tour to

Denmark nursing student. Attended cardiology case presentation. Worked on simulation competency checklist.

6.25


2014

7:00 am – 8:00 am, 8:00 am – 11:00 am,

11:00 am – 12:15 pm, 12:30 pm – 1:00 pm, 1:00 pm – 2:00 pm, 2:00 pm – 4:00 pm

Attended Simulation operator meeting with preceptor. Worked with preceptor throughout the day. Finished

designing rubric for evaluation of oral presentations. Met with chair of ethics committee. Met with HR. Met with two interns

from the last internship class. Emailed rubric to interns.

8.75


2014

7:00 am – 7:30 am, 9:00 am – 10:30 am, 12:00 pm – 1:30 pm, 1:30 – 2:00 pm

Reviewed emails. Completed some research related to evaluation of clinical performance. Met with simulation

coordinator to prepare for next week’s skills lab.4


22


Week 6 Summary

This week started with attending the second meeting for the subcommittee working on making

modifications to the professional practice model. My preceptor was out of town, so she I actually attended

the meeting without her. In continuing working on the competencies and evaluation for the simulation

activity I utilized Munson’s intranet and information from the Lippincott reference manual. I was also able to

find some Munson checklists for evaluating competency with assessment and information about ventilator

management that I could utilize for the simulation.

On Wednesday I was able to meeting with my preceptor again and spend the day with her. We

discussed the subcommittee meeting that preceptor couldn’t go to. We discussed how the interns were

given feedback about their upcoming case study presentations. Based on this discussion, I began

developing a rubric that could be used to evaluate the presentations. Later this day, my preceptor and I

met with a nurse and critical care student from Denmark that is hoping to complete an intensive care unit

rotation at Munson. We met with her in the cafeteria and discussed her educational background,

possibilities, and issues. We took her on a tour of the intensive care unit, A2, and A3. We received

permission to allow her to take a picture of an empty room to take back with her to Denmark. Upon

introducing her to the manager of A3, the manager invited us to attend a cardiology imaging case

presentation that she thought might be interesting for the Denmark nurse to see. The case presentation

involved discussion related to ethical care with internal defibrillators at the end of life. At the close of the

conference, my preceptor and I went back to her office and I worked for a little while longer on the checklist

for the physical assessment simulation.

Thursday was another busy day with many meetings. My preceptor and I attended a simulation

operator meeting that discussed data, measurement of outcomes, the simulation website, quality,

equipment needs, and goals. We also met with the chair of the ethics committee regarding an

organizational policy that has caused moral distress on my preceptor and hiring for the internship. In

23

addition, we met with someone from HR in order to update and make changes to the entry requirements for

next hiring class of critical care interns. My preceptor had me work on making changes to the format of the

job posting as it has caused a lot of confusion in the past. I re-wrote the listing and emailed corporate

communications for a picture that had previously been used in relation to the internship program. Lastly,

my preceptor and I met with two individuals from the last critical care internship class that needed some

help with their presentation outline. I stayed and worked with them for an additional hour in retrieving some

articles from the unit’s reference manual and reviewing their PowerPoint. I also gave them the finished

presentation evaluation rubric that I completed earlier in the day, to the two interns and sent the rest of the

interns the evaluation rubric as an attachment via email.

On Friday, I waited for my preceptor outside her office at the specified time we were going to meet.

I was able to retrieve emails on my phone while waiting. I received an email that my preceptor would not

be in until 9 am. I decided to leave and go to the computer lab and work on some non-school related items

until I went back to my preceptor’s office and waited again. While waiting, I read information by Bonnel

(2012) on evaluation of clinical performance. When I still had not heard from my preceptor at 10:00 am, I

emailed again and she eventually replied that she was working from home. I ended up going back to the

computer lab and had lunch until noon when I had a meeting with the simulation coordinator to prepare for

skills lab session on cardiac assessment next week. We ran through the previous simulation, discussed

changes we would like to make since there was only anticipated to be four people at the skills lab. We

decided to add an additional scenario on congestive heart failure that I found in their scenario book. Next,

we discussed what additional things we wanted to do and who would complete the roles of operator and

facilitator. Finally, I retrieved materials from A2’s unit educator on heart tones that had been used at the

skills lab for the station on heart sounds that the simulation coordinator and I decided we were going to co-

teach for the first hour of the skills lab.


24

At the start of this week, I was a little nervous about attending the subcommittee meeting without

my preceptor. However, she had emailed the group and let them know that I would be attending without

her and I felt a little better that she had given them a notice. The meeting ended up being only four of us

for most of it and then the director of nursing showed up for a small portion of it. One thing that was

brought up during the meeting, which was controversial and brought up at the Nurse Practice Council

meeting, was the idea of back rubs being part of our professional practice meeting. My preceptor and I had

already talked about this as being a controversial subject and how opposed to this we were to this being

part of our professional practice model. It was our opinion that this brought the image of nursing back to

the olden days of nurses in heals, etc. and that this just was not a normal practice of nurses at the bedside.

Of course, this subject did get brought up at this meeting and the chair brought up this topic to me. I tried

to nicely describe my opposing feelings towards this idea and the fact that I thought it had the potential to

really irritate nurse at the bedside in light of the shortages, budget constraints, and extra responsibilities

already being placed on the nurse. I personally felt like the idea of adding this to the professional practice

model showed how out of touch some of those not in beside nursing positions really were. While I did not

like that I had to be the one to bring these feelings up to the committee (since my preceptor wasn’t there), it

did go over fine and we ended up modifying it so as to make it an idea for care as opposed to a

requirement.

Wednesday and Thursday left me thinking a lot about law and ethics. It was really interesting to

meet with a nurse from a different country and hear about their differences in education and what

requirements it would take to allow her to complete an orientation period in the intensive care unit. I

learned that her perception of the United States was that people would not receive as much end-of-life care

in the hospital as they do in Denmark although this was the opposite of what I thought her perception would

be. The cardiology case study conference also prompted a lot of ethical questions. Information was

presented about how a third of patients receive painful shocks from the internal defibrillators in the

moments before their death, as a result of doctors not deactivating the devices. While this case conference

25

was not exactly directed towards fulfilling practicum goals, I was really impacted by this discussion. I am a

strong patient advocate and hearing this discussion and how some cardiologists treated this so differently,

really upset me. On Thursday, my preceptor and I also spent some time talking with the chair of the ethics

committee due to an organizational policy that has had an impact on my preceptor. I do not want to share

any more about the particulars of the situation, but I will say that this was a great resource to learn about

and I was able to take a lot away from the meeting. Although I was aware of the ethics program at our

organization, I had never spoken with, or met the chairperson. He was awesome and it was really

empowering to hear his take on things and the tools he was able to provide us with in ethical dilemmas.

Friday started out frustrating since my preceptor did not do a good job of communicating with me

about her plans. Apparently school was cancelled for her kids and her babysitter fell through.

Unfortunately I was already at Munson and waiting for her, so it was somewhat of a wasted morning. The

afternoon, however, was very valuable. In preparing for the skills lab and simulations, it was nice working

with an educator from staff development. She valued my opinion about tweaking the simulations and it was

good being able to practice what my role would entail.

Analysis

In looking at the literature related to supporting the experience of meeting with the nurse from

Denmark, I was somewhat surprised to see the ANA & NNSDO (2010) providing support for this

experience. However, in looking at the role of NPD specialist it was noted that in the current environment

of growing internationalism, nurse educators need to have an understanding of international differences in

educational requirements, competence, licensure, educational facilities, as well as agencies that affect the

NPD specialist. While I had already felt the experience to be valuable, it was great to see the support for

this experience in the literature, validating my experience even further.

In regards to the ethical issues that presented themselves this week, standard five for the NPD

specialist notes the importance of developing decisions and actions that are ethically sound (ANA &

NNSDO, 2010). One measurement criterion for this standard speaks to the ability to seek appropriate

26

ethical consultation as necessary. Thus, my preceptor not only identified accurately identified an ethical

dilemma she had encountered but sought appropriate consultation related to the dilemma. This experience

also showed me the proper routes within the organization, should I encounter an ethical dilemma myself.

Rubrics are a type of rating scale and can be used to help provide a clear direction for grading and

assignment criteria (Bonnel, 2012). Since the case presentations by the interns are an important

evaluation component to the internship program, it was deemed necessary by myself and my preceptor that

a rubric could be utilized to help facilitate a clearer understanding of the expectations for the presentation.

The only direction interns had related to this experience was through verbal communication. Rubrics can

be a convenient form for providing feedback and allows for more discrimination in judging than checklists

(Bonnel, 2012).


Hours

7


2014

10:00 am –12:00 pm, 12:00 pm –1:00 pm, 2:30 pm – 5:30 pm

Attended another subcommittee meeting about making modifications to the organizations professional nurse practice

model. Met with preceptor. Prepped for teaching of heart tones skills lab and simulation lab.

6


20147:00 am – 12:30 pm

Set up simulation lab prior to start of lab. Co-facilitated at heat tones skills lab and was the simulation operator for simulation stations. Observed debriefing and helped facilitate some of the

debriefing discussion. Helped with sim lab clean-up. Briefly looked at simulation evaluations.

5.5


2014

9:30 am – 11:30 am, 3:30 pm – 7:30 pm

Attended educator meeting. Met with preceptor and helped with looking at resources for next class of intern’s orientation books.

Helped put books together. Reviewed evaluations from simulation and emails forwarded from preceptor related to internship.

6


201412:30 pm – 5:30 pm

Put together an assignment description for internship case presentation requirement to add to orientation book. Finished

physical assessment simulation checklist and added references to teaching outline. Researched info about using a rubric for self-

assessment of simulation and what Patti and I will use for evaluation of the simulation activity itself.

5



Week 7 Summary

My preceptor and I started this week by attending what was supposed to be the last subcommittee

meeting for the modifications to the professional practice model. However, it was decided by the group that

we wanted one more meeting after the chair of the group was able to present what we had come up with to

27

the director of nursing. After the meeting, I was able to meet with my preceptor for a short meeting to touch

base with where we were at with projects and internship planning. I also completed some preparation for

the skills lab on heart tones and cardiac assessment simulations by looking up information about heart

sounds and their location, cardiac drugs we are using in the simulation, and the teaching outlines the

simulation coordinator had emailed me after our Friday meeting. On Wednesday, the simulation

coordinator and I met before the skills lab started in order to get the lab ready and run through the

modifications we had discussed. We then facilitated the first skills lab station on heart tones for the first

hour. We ended up having seven individuals instead of four that we taught all at once for the first station.

For the two simulations, we broke them up into one group of three and then two groups of two. The

simulations ran for one hour total for each group. Unfortunately, the facilitators of the other skills stations

ended up taking longer than they were supposed to so we ended up waiting for a while in between our first

and second groups for the simulations.

To complete the rest of the week, I was able to attend an educator meeting that discussed changes

to the meeting due to a change to the shared governance structure. The group discussed still meeting

once a month due to the value of the meeting felt by those in attendance. Information related to a change

in fall risk patients transitioning to yellow socks was also brought up and the education about how this

would be delivered to staff nurses. The educator for vascular access also presented information that was

recently placed on Munson’s intranet related to central lines, nursing care, and patient education. On

Friday, I worked from home on creating an assignment description for the case presentation requirement

for the internship and finishing up the details necessary for the simulation evaluation.


The first half of this week went well. The subcommittee meeting only had five individuals in

attendance, including myself, but we got through what we wanted to accomplish pretty easily and the group

seemed to agree on most things. The skills lab was a great experience towards achieving my practicum

goals. I was once again able to work with the educator in staff development and she is teaching me a lot

28

about facilitation and debriefing in simulation. She has a master’s degree in nursing education and she is

utilizes current research related to best practice of simulation techniques. I was able to not only observe

her as she facilitated the heart tones station but also to jump in on a few things as well. She is open and

made the students feel comfortable. She also did a good job of eliciting active participation during the

station. During the simulation scenarios I mostly acted as the operator and played the voice of the manikin.

However, I was also able to participate in the debriefing by bringing up some questions related to

medications during the scenario. During a break between simulations we were able to look at the first set

of evaluations and brainstorm about ideas for future simulations.

The second half of the week was more frustrating as I was supposed to meet with my preceptor

and spend time with her throughout the day but both days her kids had school cancelled and she had to

work from home. I was able to go to the educator meeting without her but I did feel slightly uncomfortable

at the start of the meeting since I did not know a lot of the people there. However, I did not the co-chair and

she introduced me and made me feel more at ease. Once again, I did find it beneficial to attend this

meeting as it was attended by all the unit educators. Interestingly, the group actually discussed how

valuable they felt the meetings were to them for planning changes due to the feeling that they are really the

ones that are closest to the bedside nurses and understanding how changes should be rolled out the staff.

Analysis

The last stage in developing my lesson plan for the simulation session was determining evaluation

methods. This should be a twofold evaluation, considering evaluation of student learning or outcomes and

evaluation of the instruction or the process (Saunders, 2003). Primary strategies for evaluating and

measuring learning in a clinical setting is through observation, written communication, oral communication,

simulation, and self-evaluation (Bonnel, 2012). Accordingly, Bonnel (2012) notes the importance of

creating a checklist of behaviors and skills to be observed during the simulation or performance so the

potential for direct visualization and confirmation of student performance is easier to evaluate. Thus,

structured observational tools can contribute to a more objective and fair evaluation. Based on this notion, I

29

decided it was best to create a checklist to use during the simulation. In addition, since self-reflection can

provide students with a chance to think about what they have done and promote reflective clinicians, I felt a

rubric evaluating self-confidence would also be important to use (Bonnel, 2012). This would also help us

evaluate our learning outcome of increasing self-confidence.

According to Saunders (2003), evaluation of instruction or the educational process can be done

formally or informally. Informal examples might include remarks from a student or students during the class

session. Formal evaluation forms administered to students are often used by institutions at the end of a

course in order to solicit feedback on various criteria (2003) and could be another way to receive instructor

feedback. It has been shown that student ratings are considered highly reliable as well as positively

correlated with student achievement, however, there remains challenges with the validity and reliability of

the instrument used to evaluate teaching effectiveness (Hayes, 2011). My own reflection and my

preceptor’s reflection and self-evaluations could also additional forms of evaluation related to the learning

process.

30

References

American Nurses Association and National Nursing Staff Development Organization [ANA &

NNSDO]. (2010). Nursing professional development: Scope and standards of practice.

Silver Spring, MD: Nursesbooks.org.

Billings, D. M. (2012). Developing learner-centered courses. In D. Billings & J. Halstead (Eds.),

Teaching in nursing: A guide for faculty (4th ed.). (pp. 160-169). St. Louis, MO: Elsevier

Saunders.

Bonnel, W. (2012). Clinical performance evaluation. In D. Billings & J. Halstead (Eds.),

Teaching in nursing: A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier

Saunders.

Brunt, B. A. (2007). Competencies for staff educators: Tools to evaluate and enhance nursing

professional development. Danvers, MA: HCPro, Inc.

Jeffries, P. R., & Clochesy, J. M. (2012). Clinical simulations: An experiential, student-centered

pedagogical approach. In D. Billings & J. Halstead (Eds.), Teaching in nursing: A guide

for faculty (4th ed.). (pp. 352-368). St. Louis, MO: Elsevier Saunders.

National League for Nursing [NLN]. (2012). The scope of practice for academic nurse

educators 2012 revision. NY: Author.

Hayes, J. (2011). Student evaluation of teaching. In M. Bradshaw & A. Lowenstein (Eds.),

31

Innovative teaching strategies in nursing and related health professions (5th ed.). (pp.

563-574). Sudbury, MA: Jones & Bartlett Publishers.

Saunders, R. (2003). Constructing a lesson plan. Journal for Nurses in Staff

Development, 19(2), 70-80.

START OF JOURNAL 3


Hours

8

Monday, March 3

8:00am – 1:00pm,1:00pm – 2:00pm

Met with preceptor. Reviewed case presentation assignment description I created. Worked on putting together orientation

books for new interns. Discussed need for internship program syllabus and what ideas for what should be included. Attended

meeting regarding the content of the pulmonary skills lab. Discussed feedback, learning objectives, and desired

modifications to that particular lab.

6

Monday, March 3

3:00pm – 7:00pm, 8:00pm – 10:00pm Began creating a program syllabus 6

Tuesday, March 4 10:00am – 11:00am

Went to sim lab dress rehearsal for unit’s mega code and procedural sedation competency. Learned operator and facilitator

role so I could help with either or both.1

Thursday, March 6 6:30 am – 12:30 pm

Set up sim lab for mega codes. Facilitated, operated sim man, and helped debrief sessions throughout the day. Cleaned up sim

lab upon completion. Reviewed evaluations.6

Thursday, March 6 1:30 pm – 7:30 pm Continued working on program syllabus 6

Friday, March 7 8:00 am – 1:00 pm Continued working on program syllabus. Emailed completed

syllabus to preceptor for review over the weekend 5

Friday, March 8 1:30 pm – 7:30 pm

Set up sim lab for mega codes. Facilitated, operated sim man, and helped debrief sessions throughout the day. Cleaned up sim

lab upon completion. Reviewed evaluations.6



Week 8 Summary

This week started with meeting my preceptor and looking at what else needed to be accomplished

before the internship started. In looking through what would be included in the internship binders, we

discussed the need for more of a “roadmap” to what all the internship entailed. Thus, I came up with my

next big project of creating a program syllabus. I found that my preceptor did have written program goals

but there was really nothing formal, written, and given out to the interns that described all the things that a

32

normal program syllabus would contain. My preceptor agreed this would be a great item to add to the

orientation binder and agree to let me work on it. We discussed some possible items that we would like to

include and I took notes. I began working on this in her office while she worked on some other items for the

binders, checked emails, etc. Thus, I was able to see what activities she was also working on as I worked

on the syllabus. Later in the day, we had a meeting with the ICU educator and staff development educator

regarding the pulmonary critical care skills lab. We discussed evaluations from the last lab and proposed

modifications with the future labs. After the meeting, I went home and worked on further development of

the program syllabus. I knew I did not have much time to accomplish this task before the first meeting with

the interns, so I worked diligently in getting as much done as I possibly could. In doing this, I also had to

email the EKG class instructor and asked for information about the class to add to the syllabus. I also had

to look at what the American Association of Critical-Care Nurses used for learning objectives related to the

online modules that the internship utilizes for didactic learning. I continued working on the syllabus on

Thursday and Friday and was able to email the finished product by Friday afternoon to my preceptor.

On Tuesday, I attended a one hour dress rehearsal for a simulation. The simulation was on

procedural sedation combined with the annual mega-code competency for the unit I work on. I agreed to

help with this opportunity to further my practicum goal of gaining competency in facilitation of learning

through the use of simulation technology. During the dress rehearsal, I learned the facilitator (including

debriefing) and operator roles for the particular simulation scenario so that on Thursday and Friday, when

the lab was reserved for the simulations, there would be a total of three of us that would be able to rotate

roles in order to keep groups moving on schedule. Thursday and Friday, I helped facilitate and debrief, as

well as operate throughout both of the days. I also worked collaboratively in setting up and cleaning up the

simulation labs. Finally, we also looked at and reviewed the evaluations.


This was a very busy and exhausting week! However, I felt like I really did a lot independently and

was able to gain some valuable experience in working towards my practicum goals. I honestly was

33

surprised that the internship program did not already have a syllabus that outlined learning objectives, how

interns would be assessed, and requirements for the program. I felt this was a huge gap that needed to be

addressed and was excited to work on what I believed to be a very important clinical project. I also knew

that my time for creating another didactic lesson for the internship was looking like a difficult task, based on

how difficult it can be to have extra time outside of all the requirements the interns already are faced with. I

felt this would be a great learning experience for me and would allow me to see the interconnectedness of

the components that make up the internship program. With my preceptor not having a background in

nursing education, I believe this was also an area she was struggling with, so I was hoping that my working

on it would be a big help to her. Having created a syllabus in a previous Ferris class, I did not find this

activity to be too difficult. I basically just started gathering information from what I already knew and looking

at syllabus examples as a guide to getting started. Once I gathered the information and did some

additional research I felt like pieces of the syllabus came together easier than I expected. It was a time

consuming activity and biggest worry was just making sure I could get it done on time to be utilized for the

new class of interns. The fact that I was able to complete the first draft before the weekend made me

personally happy and relieved.

Preparation and helping with the simulation was a lot of fun. I really enjoy this learning activity and

feel it has a lot of value, especially for the particular topic of this simulation. Stephanie did a great job of

creating a poster for using to explain the purpose of the simulation and this made it easy to jump in as a

facilitator when needed throughout the simulation days. She also had a detailed lesson plan with operator

responsibilities and debriefing questions. The simulations overall I felt went very smoothly. A couple of

times we did have to wait between groups. While waiting, however, we were able to go over some of the

evaluations and make any improvements for the next group. I also enjoyed being able to jump in as

needed in the various roles and felt that spending two days in the lab really gave me more confidence with

running the technology in the lab and being able to function in the various roles.

Analysis

34

A syllabus can be seen as an important component to student understanding of what is expected

of them throughout a course. According to Sauter, Nightingale Gillespie, and Knepp (2012), the syllabus

can also be used during review of instructors and effectiveness in teaching. Furthermore, the syllabus

should be reviewed for expectations that are clear and evaluation methods that are detailed. Billings

(2012) also notes that the syllabus sets the tone for the course and should start off by being written in a

welcoming style. In addition she says a title, purpose, description, prerequisites, corequisites, outcomes,

teaching-learning strategies, learning activities, topical outline, policies and procedures, assessment and

evaluation strategies, as well as the grading plan should be standard and essential components in a

syllabus. Keeping this information in mind and the difference between creating the program’s syllabus I

needed to create for the internship to one that would be created for an academic course, I set out to the

task of creating a program syllabus.

The first step was to figure out the course outcomes. Although, my preceptor had already created

some broader program objectives, I felt the syllabus needed to have more specific intern learning

outcomes. Objectives and outcomes specify what students should know, do, value, and determine how

they will be graded (Billings, 2012). Dillard and Siktberg (2012) also note that objectives and outcomes

provide the framework for the curriculum. Learning activities and course objectives should also focus on

the three main domains of learning, the cognitive, affective, and psychomotor domain. Matching objectives

with learning activities allows students to make connections between what the content is and why it is

important, thus, promoting learning. One way to demonstrate that learning objectives match the

assignments is to use an evaluation grid or matrix. Therefore, I did create a grid to demonstrate how the

learning objectives would be assessed. It was also really great to see that in looking at all the various

learning activities utilized in the internship program, that there was a great mix of active and passive

learning approaches.


Hours“Spring Break”

Monday, March 10,

2014

12:00 pm – 5:00 pm

Met with preceptor. Reviewed syllabus. Made changes per discussion. Discussed plans for week and outstanding tasks that need to be

completed prior to internship starting on Thursday. Continued putting

5

35

orientation books together.

Wednesday, March 12,

2014

10:30 am – 2:30 pm,

2:30 – 3:30 pm

Met with preceptor. Reviewed table of contents to orientation book, decided to modify how some content was presented. Added more

detail and examples to case study assignment description. Created self-evaluation tool for case presentations. Met with staff development

educator to discuss new education that she wants me to help with. I will be putting together content that will be utilized for a healthstream

presentation. My content is related to tachycardia.

5

Thursday, March 13

7:30 am – 4:30 pm First day of internship program 9

Friday, March 14

7:30 am – 4:30 pm Case study presentations 9

Week “Spring Break” # of Hours 28

Cumulative Total Wks. 1-“Spring Break” 201.5

Week “Spring Break” Summary

This week started on Monday by meeting with my preceptor and reviewing the program syllabus I

created the week before. I made changes to the syllabus. We also worked on some additional

housekeeping items that needed to be completed prior to the internship start. This included finishing up the

details to the agenda for the first day, looking at the schedules again, and continuing to put the orientation

binders together. Wednesday was more of these types of activities. Since the binders were essentially

complete we also looked at reorganizing the way some of the material was laid out. This is led to addition

more description to the case study assignment. I went through examples and added those to the syllabus.

In addition, we discussed the benefits of self-evaluation for the case study presentation. This led to me

creating a short self-evaluation tool for the case presentations and adding this to the binders as well.

I ended Wednesday by attending a meeting with the staff development educator. The meeting was

requested on the behalf of the staff development educator. Since I have worked with her several times now

on various items, she was soliciting my help for another project. I agreed to help as I felt it would work

towards my goal of curriculum design. She and a few other educators are working on putting together a

healthstream course for the units that will not be getting their nurses ACLS certified. The education we

would be putting together was approved to allow nurse to still have some background knowledge around

arrhythmias but not be as costly as having nurses obtaining ACLS certification. I agreed to work on the

section of tachycardias. She gave me an example of the section she created on bradycardias. My

36

responsibility for this activity will be to create the content (via a lesson outline) that will then be utilized in

the creation of the healthstream learning program. The healthstream itself will be created by other

individual(s) after we develop all of the content.

Thursday was the first day of the internship. My preceptor and I met with the interns and went

through introductions. We administered BKAT exams and reviewed the syllabus. Next we went on a tour

of the units. When the interns had a break for lunch, my preceptor and I met in her office and discussed

how the day was going. After lunch, we met with the interns again and they had their class picture taken.

Next we discussed stress and self-care. After that we all went to the simulation lab and the staff

development educator gave an orientation to the sim lab. EKG class was discussed as well. Finally, the

day came to a close with an opportunity for the interns to ask questions and have a meet and greet with

unit educators, managers, preceptors, and nursing administrators.

Friday was an entire day of the last class of interns, which had a total of seven interns, giving their

case presentations. The new class of interns were required to watch the presentations. My preceptor and I

evaluated the presentations. Post BKAT exams, program evaluations, and preceptor evaluations were also

administered to the last class of interns.


It was busy Monday and Wednesday with just tying up loose ends and making sure we had

everything prepared before the first day with the interns. I was excited for the start of the next chapter of

my practicum and the opportunity to work with new nurses. I was a little nervous about getting everything

accomplished that my preceptor and I wanted to before Thursday. We still had the orientation books that

were not completed and I still had areas my preceptor wanted me to fix on the syllabus. Overall, my

preceptor was very happy with the syllabus and she had some great ideas about how to modify the design

of it to table of contents in the orientation binder. The various sections were able to correspond to the

sections in the binder and it really seemed to pull everything together to make for a more comprehensive

and cohesive program orientation binder.

37

The first day of the internship was a whirlwind. I was able to observe a slew of emotions from the

interns and see what it was like to introduce them to the program. It was exciting hearing about their

backgrounds and what their impressions, fears, and anxieties are related to the program. I was able to give

the tour on the unit I work and I found their excitement very refreshing. With such a small group, I felt more

at ease with talking to the interns and did not really have the typical anxiety I feel with talking in a group

meeting with people I don’t know. It was also nice to hear that three out of the four interns already knew

each other from either school or working together and that the other intern had already gotten to know the

others through hospital orientation. I observed the group to really get along well and forming a good bond.

The case presentation day was another exciting day. Since I had been a primary preceptor for one

of the past interns and gotten to know several of the interns through the critical care skills labs, it was really

rewarding to hear them discuss some of the knowledge they had obtained throughout the internship

program. My preceptor and I utilized the case presentation rubrics for evaluating the presentations and we

also passed out the self-evaluation tools I had created. I did find it somewhat difficult to evaluate the

intern’s presentations using the rubric because I would have liked more room to write comments. Although

I think the dimensions on the rubric were pertinent and useful for evaluation, I wanted to make sure the

feedback was also specific and detailed if I noticed their presentation was particularly good in one area or

lacking something in another area. Since I have not had to provide feedback on presentations like this

before I also felt like needed to watch all of the presentations to have a comparison to evaluate them

against one another. After the presentations, I had a chance to talk with the new class of interns and hear

their perspectives about the presentations and their first two days in the program. It was good to hear that

even though the interns felt very overwhelmed after the first day, that they felt more at ease after listening

to the presentations. I tried to encourage them and was happy to hear that they were feeling less

overwhelmed.

Analysis

38

Planning effective learning strategies for a new group of students should take into consideration an

understanding of the unique perspectives and learning needs of the individual students themselves

(Burruss & Popkess, 2012). In meeting the four interns, I was able to assess that all four of the interns are

representatives of Generation Y. According to Buruss and Popkess (2012), this generation is generally

described as optimistic, team-oriented, high-achieving rule-followers, and accustomed to living highly

structured lives planned by their parents. Additionally they noted that it is important for the nurse educator

to understand that this generation is accustomed to immediate feedback and classroom structure and that

ensuring safety within the clinical experience is important. Moreover, this generation is technologically

capable and places a greater importance on doing over knowing.

Student case presentations can provide teachers with the opportunity to probe for more detail

regarding a student’s understanding, or lack thereof (Bonnel, 2012). In addition, they can help learners

improve their presentation skill and evaluate their thoughts and approaches related to various aspects of

patient care. The use of a self-evaluation tool for the interns following their presentations can also promote

critical thinking. The evaluation rubrics were given to the interns prior to the presentations, and according

to Bonnel (2012), help convey assignment expectations, provide clear direction for graders, and can

increase reliability between graders.


Hours

9

Monday, March 17,

20144:00pm – 6:30pm Prepared and reviewed resources for ecco skills lab on cardiac

output measuring for Thursday’s skills lab. 2.5


2014

8:00 am – 3:00 pm,3:00 pm – 4:00 pm

First day of familiarization for interns. Rotated between units with preceptor and met with interns and preceptors. Facilitated learning

& socialization to units. Met with staff development educator for dry run and review of simulation I will be helping with in a few

weeks for new hospital orientees.

8

Thursday, March 19,

2014

7:30 am – 10:30 am, 11:00 am – 3:00 pm

Set up for hemodynamics skills lab. Helped with mega code simulation facilitation at one of the skills stations. Independently

facilitated cardiac output station. Cleaned up. Independently went to units and met with interns for the rest of the day.

7

Friday, March 20,

2014

7:30 am – 10:00 am,10:00 am – 11:30am, 12:00 pm – 4:00 pm

Independently went to units and met with interns. Independently set up for physical assessment simulation. Facilitated, operated, and debriefed physical assessment simulations independently for

first 1.5 hours. Reviewed evaluations.

8


39


Week 9 Summary

This week started off with preparation for the skills lab I will be teaching on Thursday. I reviewed

the teaching outline for my section and looked for some images to utilize for my station. I looked at

Lippincott’s standards for the procedure and the checklist I would be utilizing for completion of the skills

station. I reviewed additional hemodynamic information related to cardiac output that I was planning to

teach about during my station.

Wednesday morning I met with my preceptor and we began by rotating through the various units

and meeting with the interns for their first day of familiarization on the units. We stopped in to discuss and

issues, make sure they were getting experiences desired, and that everything was going well. After

spending the day going to the various units, I met with Lauren, one of the other staff development

educators for a dry run of a simulation scenario I said I would help her with. She needed an operator for a

simulation planned for April 2, during hospital orientation. We had a dry run of the simulation planned and

what my responsibilities would entail.

Thursday I went to the simulation lab to set up for my cardiac output skills lab station. I was also

asked to help with the mega code simulation station since there were only a couple of individuals coming to

the lab today. I agreed to help with that since I was only just waiting for the individuals to come to my

station anyways. I helped with facilitating the mega-code and debriefing. Next the individuals came to my

station and I facilitated the lesson on cardiac output. I demonstrated proper method for shooting a cardiac

output and had individuals perform the skill back to me. My preceptor ended up having to leave before I

was even done with skills lab because she had gotten a phone call that her child was sick. She asked me

to complete rounding on the interns and make sure everything was going okay. Once I was done in the

skills lab I did just that.

Friday morning I also came in and rounded independently on the interns as my preceptor was not

able to come in until 1:30. I went around to all the units and checked in with the interns and preceptors.

40

After a few hours, I headed to the simulation lab and set up for the physical assessment simulation I had

planned. I coordinated obtaining a ventilator to utilize in debriefing. The interns joined me in the sim lab

and I discussed the learning objectives and expectations for the simulation. The interns then came in to the

simulation one at a time and I presentation the scenario as the facilitator and then ran the 3G manikin while

the interns independently ran through the scenario. At the completion of the scenario, I individually

completed a short debriefing. Two of the interns completed the scenario before my preceptor showed up.

Once my preceptor showed up, she joined the simulation scenario and took on an observation role. She

also was able to act for the manikin in carrying out additional parts of the neurological assessment. After,

the last two interns went through the simulation, my preceptor and I separately discussed our observations

while the interns finished up charting their assessments in the other open lab. We decided it would be best

for me to act as a patient and for her to demonstrate a proper head-to-toe assessment. We ran through

this demonstration and allowed the interns opportunities to ask questions. Finally, we finished up the

learning session by utilizing the other manikin that I had intubated and demonstrated additional assessment

items required of a vented patient. We obtained written evaluations for the simulation and I gathered up the

results.


Preparation for the skills lab is getting easier. I know more about what to expect and the topic I

was in charge of teaching this time was one I am very familiar with. One thing that I did find a little difficult

was that when I actually got to the lab to set up one of the other facilitators was confused about what my

role would be. I guess the last time she did her station she covered the material I was planning on

covering. I explained what outline of materials I was given to facilitate with and how I believed our stations

would be. We worked out the details and the lab seemed to run smoothly overall. There was also

confusion about who was going to help with the mock code simulation. I volunteered and this seemed to

alleviate the confusion. I did feel the preparation and communication surrounding this particular lab could

have been better. There was only one email to the group about the lab and then other people had

41

responded about issues and concerns but there was no confirmation before the day of the lab. Knowing all

of this, I went into the lab with the attitude that I would just be flexible with whatever anyone wanted me to

facilitate, help with, or not do. I just tried to be as open as possible with what I had been told and let

everyone know I was willing to do whatever was necessary. After communicating with facilitators prior to

the start of the lab, I felt we were all able to sort out who was doing what and come to an agreement.

Going to the various units and meeting with the interns and preceptors was a lot of fun. I

thoroughly enjoyed these times and am looking forward to developing in this role. I love hands-on teaching

and the excitement the interns have when going to the various units. I liked being able to go around with

my preceptor the first time so I could be more comfortable going on the units I am more foreign to. It was

nice meeting preceptors on the various units and hearing about the patients the interns are working with.

Being able to go around on Friday by myself was exciting and a little scary at the same time. Of course, I

felt the most at ease on my unit and started my rounding here. Going to the ED was probably the unit I had

the most apprehension about. Although I have only been to the ICU and A3 a handful of times, I had only

been to the ED twice. It feels very big and I worry that I will get lost! I found it awkward to walk around

looking for the intern and thinking that I look stupid wandering around. In the end, it was not that bad at all

and after doing it, I actually felt much more comfortable and ready to continue in this role.

The simulation was really a big project for me and I was actually really excited to finally get to this

day. I was nervous that the interns would think it was stupid or not very beneficial. As I began running the

simulations, I gained more confidence. Debriefing went smoothly and I noted that the interns were more

prone to point out all of the things they needed to do better. Based on this, I tried to offer positive

reinforcement and encouragement for the things they did well. Looking at the evaluations, the interns rated

the simulation highly and said they felt it was a very worthwhile activity. This definitely made me feel good

about all the work I put into the simulation. My preceptor was also impressed and gave me positive

reinforcement on all my work in putting the simulation together.

Analysis

42

In analysis of this week and the start of familiarization and clinical orientation of the internship

program, I reflected on what the literature says about how to promote effective learning. For example,

Bradshaw (2011) states:

The best ways faculty can bring about effective learning are by recognizing students as individuals,

with unique, personal ways of knowing and learning, by creating learning situations that recognize

diversity, and by providing empowering experiences in which students are challenged to think. (p.

14)

According to the National League for Nursing (NLN, 2005), nurse educators are responsible for using

various strategies to assess and facilitate learning and outcomes. Based on my assessment of the interns

and my responsibilities as a nurse educator, I believe multiple strategies will need to be used in order to

meet the learning needs of the interns. According to Burruss and Popkess (2012), once I know the

preferred learning style(s) of my interns, I can begin coming up with a plan to promote successful

outcomes. I could tailor my interns’ needs to assisting them with improvement of study habits, deciding on

a work/study environment that meets their learning needs and planning my implementation of various

content in ways that meet the learner needs and specified outcomes. In terms of teaching strategies, a

variety could be used to appeal to various learning styles (Burruss & Popkess, 2012).

A study by Forneris and Peden-McAlpine (2007) found that dialogue in developing a process of

critical thinking in practice was important. So even if the student doesn’t know the answer to a question off

the bat, using conversation and dialogue between the student and teacher in order to develop processes

for thinking through the question is just as important if not more so. The study concluded, “nursing

education should focus on facilitating critical dialogue (i.e. encouraging students to challenge perceptions,

asking questions beyond expository or declarative knowledge) making visible the nature of thinking to

broaden perspectives and reframe thoughts and insights” (p. 419). In an article by Scanlan (2001), it was

also noted that clinical teachers use their own experiences and the way they were taught in order to form

their teaching style. However, Scanlan argued that clinical teaching is a difficult skill and a greater

43

theoretical foundation is needed to assist novice clinical teachers in learning the process. In addition, the

study found that as instructors became more familiar with teaching they were able to reflect and make more

meaningful connections about ways to be effective and not just rely on exemplar experiences. As an

educator, I believe I will need to understand various ways and methods to teach so that I can appeal to

various learning styles and be able to change my teaching as required to meet the needs of the students.

These are the types of strategies I am really trying to think about and consider during my facilitation of

clinical learning activities and rounding with the interns.


Hours

10

Sunday, March 23,

20149:00 pm – 9:30pm Read intern e-journals from first week. 0.5


2014

8:00 am – 12:00 pm, 12:00 pm – 4:00 pm

Attended nurse executive council meeting. Met with preceptor and interns on various units for the start of their 2nd week of

familiarization8

Thursday, March 27,

2014

9:30 am – 11:30 am,1:00 pm – 4:00 pm

Attended nurse educator/clinical nurse specialist meeting with preceptor. Independently went to various units and met with

interns and preceptors.5

Friday, March 28,

2014

7:30 am – 11:00 am,11:00 am – 12:30 pm

Met with preceptor and went to units to meet with interns and preceptors. Post conference & debriefing with preceptor and

interns.5



Week 10 Summary

This week started by attending the first nurse executive council meeting. My preceptor was not

able to attend, so I went on my own. I learned more about the new shared governance structure at Munson

and how this council will function. After the meeting my preceptor and I were able to meet and then went to

the various units and met with the interns and preceptors for their second day of week two of unit

familiarization. This was the first time we were able to visit all the interns on the various units this week,

since both of us had to work on our own units on Tuesday and the interns still had one day of general

orientation on Monday.

Thursday, I attended the nurse educator/CNS meeting with my preceptor. I actually presented at

this meeting for the first half hour about my scholarly project. The rest of the meeting I learned about how

44

the hospital was doing with the EMR changes to the discharge process and reviewed new education

related to the process. There were also reps that came in to introduce some new IV products that units

would be trialing. After the meeting I had a break for lunch and my preceptor went to her office to work on

writing some test questions she is hoping to administer to the interns in the next few weeks. She asked me

to go around to the units and round on the interns.

On Friday, I met with my preceptor in the morning. We discussed some last minute housekeeping

tasks before she will be leaving for vacation tomorrow. I obtained the post-BKAT results from the last class

of interns and the results from the pre-BKAT for the current class of interns. Reviewed how the last class

did and some of the concerns with missed questions. I made some copies of real EKG strips (with names

blacked out) and discussed with my preceptor a plan to pass out sample strips for evaluation each week.

We discussed my observations and concerns that had come up during some of my conversations with

rounding on the interns. After our meeting, we made our way to the various units and met with the interns.

This was a short day for the interns and we finished the day with a post-conference with the four interns,

my preceptor, and myself.


I really enjoyed reading the internship e-journals and after writing journals for my own practicum

experiences I can see the value in it. I also think that it was be nice to have the journals to reflect on before

the interns make their decision about ranking the units they are most interested in ending up on. The rest

of this week I was able to gain more confidence and experience in facilitation of learning and learner

development and socialization by rounding on the interns in the various units. I feel I am getting better at

asking the right questions to understand more about what they are learning and addressing possible

issues. One thing that did come up in one of my meetings with the interns was that one of the preceptors

was being very short and rude to the intern. Unfortunately, the intern did not tell me about it on the day it

was actually occurring and when I rounded on her it appeared that everything was going well. However,

the next day she mentioned it and I was able to talk to my preceptor about it. In post-conference we

45

addressed conflicts and handling these types of situations. I also emphasized to the interns that with Patti

(my preceptor and the internship coordinator) being gone next week, that they need to keep me informed if

this is an issue again. Patti also emailed the educator of the unit where this was an issue with the intention

of not placing any of the interns with this preceptor in the coming weeks. I am also glad to know that even

though my preceptor will not be around next week, that she is available by phone and email to help me with

any concerns. Since I have had the last two weeks with the interns, I feel I have a good rapport with them

and am excited for the responsibility of rounding on them on my own next week.

Analysis

According to French and Greenspan (2011), socialization to clinical practice occurs during

preceptorships and may be the first exposure students have to clinician roles, responsibilities, and

accountabilities. Thus, if students are exposed to staff that are lazy, incompetent, unmotivated, uncaring,

or any number of other less-than-desirable qualities, this is setting up a poor socialization experience for

students to the world of nursing. French and Greenspan (2011) also pointed out that students may have a

difficult time balancing learning between academic and work environments without their familiar support

and social systems. “The work of learning, performing in a new role, balancing new and old roles, and

making meaning of new work is an exhausting process that requires high-energy consumption by the

learner and significant support from the preceptor” (p. 439). If role models are poor it is unlikely students

are receiving the support they need during this difficult learning period.

In an article by Happell (2009), it was noted that literature has consistently shown that nursing

students value positive environments, and have a desire to be welcomed, supported, and included. In

addition, “They seek preceptors who are consistent and professional; who understand the level students

are at; and are able, and willing, to provide regular feedback regarding the student’s performance” (p. 375).

Thus, I really don’t think there are any benefits to exposing the interns to preceptors that have a bad

46

attitude during this crucial learning period. As the literature has suggested, students really benefit from

positive learning environments (French and Greenspan, 2011; Happell, 2009). Consequently, I will do my

best to mitigate any of these issues during this important time.

References

Billings, D. (2012). Developing learner-centered courses. In D. M. Billings & J. A. Halstead (Eds.). Teaching

in nursing a guide for faculty (4th ed.). (pp. 160-169). St. Louis, MO: Elsevier Saunders.

Bradshaw, M. (2011). Effective learning: What teachers need to know. In M. Bradshaw & A. Lowenstein

(Eds.), Innovative teaching strategies in nursing and related health professions (5th ed.). (pp. 1-19).

Sudbury, MA: Jones and Bartlett.

Bonnel, W. (2012). Clinical performance evaluation. In D. Billings & J. Halstead (Eds.), Teaching in nursing:

A guide for faculty (4th ed.). (pp. 485-502). St. Louis, MO: Elsevier Saunders.

Buruss, N. & Popkess, A. (2012). The diverse learning needs of students. In D. Billings & J. Halstead

(Eds.), Teaching in nursing: A guide for faculty (4th ed.). (pp. 15-33). St. Louis, MO: Elsevier

Saunders.

Dillard, N. & Skitberg, L. (2012). Curriculum development: An overview. In D. M. Billings & J. A. Halstead

(Eds.). Teaching in nursing a guide for faculty (4th ed.). (pp. 76-91). St. Louis, MO: Elsevier

Saunders.

Forneris, S., & Peden-McAlpine, C. (2007). Evaluation of a reflective learning intervention to improve critical

thinking in novice nurses. Journal of Advanced Nursing, 57(4), 410-421. doi:http://0-

dx.doi.org.libcat.ferris.edu/10.1111/j.1365-2648.2007.04120.x

47

French, B. & Greenspan, M. (2011). The preceptored clinical experience. In M. Bradshaw & A. Lowenstein

(Eds.), Innovative teaching strategies in nursing and related health professions (5th ed.). (pp. 437-

457). Sudbury, MA: Jones and Bartlett

Happell, B. (2009). A model of preceptorship in nursing: Reflecting the complex functions of the

role. Nursing Education Perspectives, 30(6), 372-376.

National League for Nursing [NLN]. (2005). The scope and practice for academic nurse educators. NY:

author.

Sauter, M., Nightingale Gillespie, N., & Knepp, A. (2012). Educational program evaluation. In D. M. Billings

& J. A. Halstead (Eds.). Teaching in nursing a guide for faculty (4th ed.). (pp. 503-549). St. Louis,

MO: Elsevier Saunders.

Scanlan, J. (2001). Learning clinical teaching: Is it magic? Nursing & Health Care Perspectives, 22(5), 240-

246.

48

START OF JOURNAL #4


Hours

11

Monday, March 31,

20147:30 am – 4:30 pm

Preceptor on vacation this week. Independently went to various units for third week of intern familiarization. Met with interns and

preceptors, coordinated OR observations for interns.9

Wednesday, April 2, 2014

7:30 am – 12:30 pm,12:30 pm – 4:00 pm

Independently went to various units and met with interns and preceptors. Simulation operator for simulation sessions that are

part of hospital orientation.8.5



Week 11 Summary

This week I worked independently with the interns since my preceptor was on vacation. I was able

to spend quite a bit of time with all of the interns on Monday. One of the interns in the ED was able to see

two patients come in that had coded. Since this was his first day in the ED I did spend extra time working

with him to see how he was handling everything, especially amidst all of the chaos. I was also responsible

for coordinating the operating room observations as the individual that usually does this for the interns was

on vacation so I had said I would do this as well. I checked on preceptor pairings for the week and made

sure everyone was set up with appropriate preceptors. On Wednesday I also spent some time in the

simulation lab again to help with one of the staff development educators. I was able to help facilitate and

operate for one group that ran through three different simulations. The first simulation was having to utilize

the Narcan protocol. The second simulation was starting a blood transfusion. Finally, the last simulation

was a transfusion reaction. All of the simulations flowed from one to the next but each of the participants

switched roles and there was a debriefing in between each of the simulations.


49

I feel I am continuing to gain confidence in my role as an educator. I am more comfortable going to

the various units and meeting with the intern. I feel I have a good rapport with the interns and they are

coming to me with questions and issues. They are also doing a great job keeping up with all of their extra

work outside of clinical time. On Wednesday when I went to talk with one of the interns I did find out that

she was placed with the preceptor that had been previously rude to a different intern. Before my preceptor

had left for vacation she had written an email to the unit’s educator asking that no intern be placed with the

preceptor until she came back from vacation and was be able to address the preceptor. Unfortunately the

email was ignored for whatever reason. When I met with the intern I spent quite a bit of time with her to

decipher whether there was an issue or not. She reassured me that things were fine and that she was not

having any problems with her. I asked her to please contact me if there was an issue and she said she

would. I separately saw the preceptor and asked how everything was going and she said everything was

going well. I did not sense any issues and felt comfortable with the situation after assessing for a while.

The simulation was another experience I was grateful to be a part of. I was able to see another

way that simulations could be broken out so that everyone could participate in different roles. It was nice

because it was only a group of three but each of the scenarios were about thirty minutes each. So we

spent time facilitating before each scenario and debriefing after each as well. As previously mentioned, I

had not seen a situation where the scenarios ran back to back with the same group but changing the

situation for the next learning objectives. The evaluations for the scenario were very good and since these

were newer nurses with about six months of experience, I felt they were great topics for them to be learning

about in the lab since they were critical competencies that are not seen that often.

Analysis

According to Knowles (1980) theory of adult learning, adults prefer learning that is practical,

promotes self-esteem, utilizes past experiences, demonstrates respect and allows self-direction, and

synthesizes new ideas with previous knowledge. The principles of adult learning provided a strong

foundation for leading my clinical instruction when meeting with the interns during familiarization. When

50

meeting with the interns, I had to keep these principles in mind and be able to communicate appropriately

with the interns in order to achieve learning goals. According to McKinley (2008), communication is

essential to the success of any role but even more so for that of an educator. Moreover, McKinley (2008)

notes that unclear, indirect, inefficient, and poor communication techniques can result in frustration and

failure. Another important consideration when communicating with learners is that too much information

can result in overload and shutting down communication (McKinley, 2008).

Additional communication strategies utilized during this time focused on the use of personal

attributes. Accordingly, the National League for Nursing (NLN, 2012), facilitation of learning competency,

notes the importance of using personal attributes such as caring, confidence, patience, integrity and

flexibility. This strategy is also supported by studies that have found faculty considered the most successful

by students when they possessed attributes such as enthusiasm, flexibility, a sense of humor,

approachability, and respectfulness (Penn, Wilson, & Rosseter, 2008). Key to promoting a positive learning

environment is the fostering of collegial working relationships with the personnel in the clinical learning

environment (NLN, 2012; Gaberson & Oermann, 2010).


Hours

12

Monday, April 7, 2014 8:30 am – 4:30 pm Met with preceptor. Went to units and met with interns for final

week of familiarization 8

Wednesday, April 9, 2014 8:30 am – 4:30 pm Preceptor not in today. Went to units and met with interns and

preceptors independently. Emailed preceptor at end of day. 8

Thursday, April 10,

2014

8:00 am – 9:00 am, 9:00 am – 4:00 pm Unit selections meeting. Familiarization 8

Friday, April 11, 2014 7:00 am – 11:00 am Met with preceptor. Familiarization. Meeting to receive unit

assignments. 4



Week 12 Summary

This was the final week of familiarization for the interns. I started the week by first meeting with my

preceptor and going over how things went while she was gone. We discussed how one of the interns was

placed with the preceptor she had asked for the interns to not be placed with. She ended up having a

51

meeting with the educator and discussing this with her. My preceptor did not want me to go to this meeting

so I went to the various units and checked on the interns. Once she was done with her meeting she went

with me to the units again and we met with the interns again. Wednesday, I once again spent time with the

interns and emailed my preceptor at the end of the day with how things went. There was a code in the

hospital during this day and I was able to grab two of the interns and take them to witness this. Thursday

morning was the meeting to determine where the interns would be placed for the remainder of the

internship. After the meeting we rounded with the interns on the units. Finally, on Friday I met with my

preceptor in the morning and read the emails the interns had written about their unit preferences and why.

We discussed how the meeting was going to go since the interns were not all getting their top choices of

where they wanted to go. We briefly went to the units and reminded the interns where the meeting to

receive their unit assignments was at and to make sure there were no current issues.


When my preceptor came back and heard that one of the interns was with the preceptor she

specifically asked for the interns to not be with, she was very upset. I felt bad because I was not sure if

there was something else that I should have done differently. As soon as I found out the intern was with

the preceptor, though, I did everything I could to assess that the situation was okay. Not once did I receive

any indication that the intern was in a bad situation or that I should have pursued contacting my preceptor.

However, in seeing her reaction to the situation I questioned whether maybe I should have. She told me

she did not think I did anything wrong and that she was mostly upset because the educator did not follow

her request and put the intern and me in that position while she was gone. I think once she was able to talk

to the intern and hear that the situation really was fine, she did feel better, but she was upset that her

request for one week while she was gone, was not followed. After her meeting she also told me that the

unit is having a difficult time getting people to precept and that was part of the reason the request was not

followed.

52

This was a difficult week for the interns. After three weeks of familiarization, all of the interns

expressed their desire to be done with traveling to various units; they were ready to have a set destination.

I could definitely sense the anxiety from them as the end of the week got closer and it was difficult to see

them on Thursday and Friday and not tell them where they were going to end up. The reason my preceptor

waits until the last thing on Friday is because in the past interns have been upset with their placement.

Knowing not all of the interns got their first choice, my preceptor and I were worried that one of them was

going to be upset. From my preceptor’s perspective she felt bad and was also anxious to have to deliver

the news, knowing the intern might cry or just be upset. Neither of us were looking forward to this potential

situation. My preceptor did share tips with me about what she tries to do in this situation and how she tries

to word things. Unfortunately there were some tears shed at the unit assignment meeting. This was

difficult but I’m glad I got to see how well my preceptor handled it.

Analysis

The ability to help students’ master essential skills and knowledge in order to become professional

nurses is so paramount that the need for preparation and development of individuals taking on teaching

roles is an important issue (Stokes & Kost, 2012). Therefore, through a variety of experiences in this

practicum, both observational and experimental, my learning and knowledge about facilitation grew,

allowing me to become more comfortable with teaching. Thus, despite this being a difficult week for both

the interns and my preceptor, I feel really good about the progress I have made as a facilitator. Research

has identified effective teachers as knowing how to teach, being clinically competent, supportive, patient,

friendly, and having the ability to maintain collegial relationships with students and staff (Stokes & Kost,

2012). Educators must also have the ability to deliver knowledge in an effective manner (2012). Through

observation, reflection, and experience I was able to gain knowledge and skill in effective clinical teaching.


Hours14 Friday, April

25, 201411:00am -12:00pm Met with preceptor. Gave copies of projects worked on throughout

practicum. Received evaluations. Discussed how interns were doing.

1

53

Saturday, April 26,

20148:00 am – 5:00 pm Attended critical care conference with interns. Thanked interns

and set closure to my working with them. 9



Week 14 Summary

This was my final meeting with my preceptor. I returned all of the BKAT tests and compiled all the

files and projects I had worked on throughout the practicum. I also gave her a thumb drive with all the

computer files of the projects to make sure she had copies. I received her evaluation and the evaluations

from the interns. We discussed how the interns were doing on their first two weeks of their assigned units.

Finally, on Saturday, I spent my last day with the interns at a critical care conference. My preceptor was

not able to attend but she wanted me to be at the conference with them. This was a great conference and

the interns really enjoyed it. It introduced them to professional development opportunities outside of work

and provided formal education on topics ranging from alcohol withdrawal and hemorrhagic shock to gift of

life and end of life resuscitation efforts.


I was glad to wrap everything up with my preceptor and provide her with copies of everything I had

done. I was happy to see that the evaluations from both my preceptor and the interns were excellent. I

thoroughly enjoyed working with my preceptor and the interns. I felt like they all made the experience that

much better. I feel I have accomplished my goals for the practicum, plus a whole lot more. I was able to

see how the educator role fits in to the rest of the organization and all of the behind the scenes work that

has to be done in order to carry out a successful program. I was able to be involved in organizational work

and practice leadership and collaboration skills. Finally, there were several difficult issues and challenges

that came up throughout the experience that allowed me to practice effective problem solving skills and

ethical decision making.

Analysis

54

According to Penn et al. (2008), faculty mentors and professional development opportunities that

promote learning about the teaching environment and opportunities to enhance teaching skills should be

encouraged for novice educators. Although the conference I attended was not focused on teaching skills, I

was able to utilize the experience to observe and analyze how effective the various speakers were in

delivering their educational materials. In addition, I was able to help the interns, during the break between

each of the speakers, to understand some of the critical care concepts that they did not understand during

the learning session. This was a great way to also promote professional development by showing the

interns the importance of attending these types of experiences. Finally, attending the conference allowed

me to gain further critical care knowledge that is needed to help prepare learners for contemporary nursing

practice (NLN, 2012).

References

Gaberson, K. & Oermann, M. (2010). Clinical teaching strategies in nursing (3rd ed.). NY: Springer

Publishing Company.

Knowles, M.S. (1980). The modern practice of adult learning. Chicago, IL: Follett.

55

McKinley, M. (2008). Walking on water and other lessons learned as a clinical educator. AACN Advanced

Critical Care, 19(4), 388-395.

National League for Nursing [NLN]. (2012). The scope of practice for academic nurse educators 2012

revision. NY: author.

Penn, B., Wilson, L., & Rosseter, R. (2008). Transitioning from nursing practice to a teaching role. OJIN:

The Online Journal of Issues in Nursing, 13(3), 1-14.

Stokes, L. G. & Kost, G. C. (2012). Teaching in the clinical setting. In D. Billings & J. Halstead (Eds.),

Teaching in nursing: A guide for faculty (4th ed.). (pp. 311-334). St. Louis, MO: Elsevier Saunders.

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