The Journal of Continuing Education in Nursing

Original Article 

Using Training Needs Assessment to Develop a Nurse Preceptor–Centered Training Program

Ya-Wen Lee, RN, PhD; Hui-Ling Lin, RN, MS; Hui-Ling Tseng, RN, MS; Yu-Mei Tsai, RN, MS; Jane Lee-Hsieh, RN, MSN

Abstract

Background:

Studies reveal that most nurse preceptor preparation programs do not meet nurse preceptors' training needs. This study thus developed a nurse preceptor–centered training program (NPCTP) in Taiwan.

Method:

The ADDIE model was used for the instructional design. On the basis of the nurse preceptors' training needs assessment, the research team developed the NPCTP. Content was adopted from the authentic experiences of preceptors and new graduate nurses (NGNs) using interview data to make 81 videos with computer avatars and 10 live actor films. Each course was taught as nine instructional events. The NPCTP was evaluated using reflection quizzes, preceptors' self-evaluations, NGNs' evaluations, and focus group interviews.

Results:

The NPCTP enhanced preceptors' clinical teaching behaviors and had a positive influence on NGNs. The NGN evaluation was even better than the preceptors' self-evaluation.

Conclusion:

This article provides the what and how for an NPCTP in Taiwan.

J Contin Nurs Educ. 2017;48(5):220–229.

Abstract

Background:

Studies reveal that most nurse preceptor preparation programs do not meet nurse preceptors' training needs. This study thus developed a nurse preceptor–centered training program (NPCTP) in Taiwan.

Method:

The ADDIE model was used for the instructional design. On the basis of the nurse preceptors' training needs assessment, the research team developed the NPCTP. Content was adopted from the authentic experiences of preceptors and new graduate nurses (NGNs) using interview data to make 81 videos with computer avatars and 10 live actor films. Each course was taught as nine instructional events. The NPCTP was evaluated using reflection quizzes, preceptors' self-evaluations, NGNs' evaluations, and focus group interviews.

Results:

The NPCTP enhanced preceptors' clinical teaching behaviors and had a positive influence on NGNs. The NGN evaluation was even better than the preceptors' self-evaluation.

Conclusion:

This article provides the what and how for an NPCTP in Taiwan.

J Contin Nurs Educ. 2017;48(5):220–229.

Nurse preceptors (NPs) are the critical link in the orientation of new graduate nurses (NGNs) to their new roles (Feng, Chen, Wu, & Wu, 2011). They are vital in facilitating the success of NGNs' role transition experience in health care work settings (French & Greenspan, 2014). An effective preceptorship training program both helps experienced nurses to become qualified and competent NPs and has a positive influence on NGNs' transition to practice (Broadbent, Moxham, Sander, Walker, & Dwyer, 2014; Chang, Lin, Chen, Kang, & Chang, 2015; Edwards, Hawker, Carrier, & Rees, 2015). However, in recent years, high NGN turnover rates (approximately 17.5% within the first 12 months) have become a global problem (Kovner, Brewer, Fatehi, & Jun, 2014). The loss of NGNs means recruiting more nurses and training more NPs to cope with the nurse shortage and NP demand.

Since 2007, the Taiwan Ministry of Health and Welfare has funded a 2-year nurse postgraduate program at teaching hospitals to increase NGN retention. Therefore, almost all NGNs have a designated NP during their first 3 months of orientation to help them become competent staff nurses. Furthermore, in 2012 the Taiwan Joint Commission on Hospital Accreditation (TJCHA) announced that NPs should have a minimum of 10 hours of training courses in six topics—curriculum design, teaching skills, assessment skills, feedback skills, production of teaching materials, and interprofessional practice education—to qualify for precepting an NGN (TJCHA, 2014). NP training courses are thus appearing in teaching hospitals across Taiwan. However, studies show that although most NP training programs offer the six required topics, topics such as guidance skills, communication skills, and emotion management, which are needed by NPs, are not included in training programs. In addition, course content is too theoretical and is conducted using a classroom lecture style (Chang et al., 2015; Lee & Kao, 2012; Tsai & Lee-Hsieh, 2015; Yang, Ou, & Tang, 2011), with few courses using video (Kang, Chiu, Lin, & Chang, 2016).

Having identified the discrepancy between the “is” and “ought” of NP training programs, the authors' research team conducted an NP training needs assessment through interviews with NPs (i.e., the target learners) and NGNs (i.e., influenced by the learners) to identify what topics and content should be included in NP training programs (Tsai et al., 2014). This article details the application of the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model of instructional design to enhance NP clinical teaching behaviors in precepting NGNs.

First, 17 focus group interviews with 63 NPs and 24 NGNs from five teaching hospitals in northern, central, and southern Taiwan were conducted to assess the training needs of NPs (Tsai et al., 2014). Based on the needs assessment, the nurse preceptor–centered training program (NPCTP) and evaluation methods were designed. Then, the authentic experiences of NPs and NGNs were selected from the interview data to make audio tapes and NP-to-NGN interaction scenario films as the teaching material, and Gagné's 9 events of instruction (Gagné, 1985) were integrated into each topic of the NPCTP. A total of 334 nurses (potential nurse preceptors, PNPs) from four hospitals took the NPCTP during June of 2015 and March of 2016. Fifty-four of the 334 PNPs finished instruction of NGNs for 3 months and became NPs. The results of the current study indicated that the NPCTP can enhance NP clinical teaching behaviors and benefit both NPs and NGNs during their preceptorship. The authors hope this study may be used as a reference for redesigning the NP training programs in Taiwan and for improving the quality of preceptorship.

Literature Review

A preceptorship is a one-to-one, reality-based clinical practice experience in which an experienced NP is teamed with an NGN. The literature demonstrates that a preceptorship can promote NGNs' role socialization and role transition and empower NGNs in their learning (Dawson, Stasa, Roche, Homer, & Duffield, 2014; Horton, DePaoli, Hertach, & Bower, 2012). Scholars suggest that a good NP should be capable of being a good role model for the NGN, build a positive learning environment (Tsai et al., 2014), establish a good NP–NGN relationship (Hilli, Melender, Salmu, & Jonsén, 2014; Kang et al., 2016), demonstrate effective teaching behaviors (Tsai et al., 2014), possess communication skills (Chang et al., 2015; Tsai et al., 2014), provide feedback and evaluation (Tsai et al., 2014; Warholak, 2009), and provide support and guidance (Haggerty, Holloway, & Wilson, 2013) to facilitate NGN learning achievement in clinical settings and adaptation to the work (Ali, 2012).

A review of the literature shows that although the requirements for becoming NPs are different at the international, national, and local levels, in general a qualified NP is expected to have completed an NP preparation program to increase NGN recruitment and retention (Whitehead et al., 2013). NP preparation programs include topics such as roles and responsibilities, learning needs and styles, adult learning theory, learning objectives, teaching strategies, evaluation skills, critical thinking, communication skills, providing support and guidance, conflict management, and teamwork (Foy, Carlson, & White, 2013; Haggerty et al., 2013; TJCHA, 2014). In addition, most NP training courses were taught in the classroom face to face (Bell et al., 2014; Epstein & Carlin, 2012) and the content is more theoretical than practical (Chang et al., 2015) and rarely involves input from NPs in designing the training courses (Chang et al., 2015; Foy et al., 2013;). An ineffective NP preparation program may generate enormous stress for NPs and NGNs during preceptorship (Chang et al., 2015; Dawson et al., 2014; Tsai et al., 2014). For example, NPs who participated in the study by Chang et al. (2015) described that “they [preceptor training course teaching materials] were not practical because I still do not know what NGNs want, how I can fulfill their needs, and how I can be the best role model for them” (p. 224). NPs preferred that the teaching content of the training programs include more practical examples of how to precept (Adlam, Dotchin, & Hayward, 2009). Further, teaching strategies, such as role-plays, films, and videos, could enhance the NP–NGN relationship and improve reflective learning (Halabi, Abdalrahim, Persson, Hedemalm, & Lepp, 2012).

Training needs assessment is foundational to educational program development. Collecting this evidence requires a broad-scoped approach to the identification of training needs (McDonald, 2005). As Altshuld and Kumar stated (2010), “needs assessment should lead to implementation of an action plan to resolve needs” (p. 28). Hence, training needs assessment could provide direction for the what and how of a training program.

The educational philosophy of the ADDIE model is that intentional learning should be learner centered, innovative, authentic, and inspirational (Branch, 2009). The systematic ADDIE model serves as a framework for educational innovation that incorporates empirical data into the teaching content (Gustafson & Branch, 2011). The description below details use of the ADDIE model to develop an NPCTP in Taiwan.

The ADDIE Model Applied: NPCTP of NP Training

Analysis Stage

To analyze NP training needs, the authors conducted 17 focus group interviews with 63 NPs and 24 NGNs from five teaching hospitals across Taiwan to explore NP perceptions of their training courses and their teaching experiences as NPs, along with the learning experiences of NGNs between March 2013 and March 2014. The primary investigator (J.L.-H.), who is not associated with any hospital, conducted all focus group interviews. The research assistant audiotaped and then transcribed the interviews. A constant comparative method was used to analyze the data and extract themes (Lincoln & Guba, 1985). These themes were integrated and recategorized into seven categories of NP training needs: committing to teaching, building a caring learning atmosphere, drafting clinical instruction plans, using a diversity of instructional methodologies, providing feedback and evaluation, giving guidance and support, and adapting to the stress and frustration of teaching (Tsai et al., 2014).

Design Stage

Based on the training needs of the NPs, the research team identified the training objectives of the NPCTP, and designed the course topics, teaching strategies, and evaluation methods. During this stage, the authors met once with an expert panel of eight nurse educators and four senior NPs from six hospitals to review the objectives, topics, outline of each topic, and evaluation methods.

Identifying Training Objectives. To enable the learners to understand learning goals, six behavioral objectives were identified. PNPs demonstrate clinical teaching behaviors to build a learning atmosphere, use appropriate teaching strategies, provide feedback and evaluation, guide interprofessional communication, show concern and support, and manage emotion.

Designing the Course Topics. The authors designed the six course topics as follows: (a) building a learning atmosphere, (b) curriculum design and teaching strategies, (c) evaluation and feedback skills, (d) communication and interprofessional practice, (e) guidance skills, and (f) emotional management skills.

Designing Teaching Strategies. Based on information processing theory, each course topic adopted nine instructional events corresponding to the nine learning phases (Gagné, 1985) and used the following teaching strategies: ask questions, video instruction, lectures, role modeling, case studies, group discussion, and reflection.

Designing the Evaluation Methods and Instruments. Evaluation of the NPCTP consists of five parts:

  • Reflection quizzes: When each course topic was completed, the PNPs completed a reflection quiz. These quizzes focused on clinical teaching behaviors as displayed in the interaction between NPs and NGNs in clinical settings. The quizzes asked questions such as “If you were the nurse preceptor in this scenario, what would you do and why?”
  • Course evaluation questionnaire: When the entire set of six topics was completed, the PNPs completed a course evaluation questionnaire consisting of five items on teaching quality, three items on teaching content, and four items on learning outcome. The 12 items were scored on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree).
  • PNP self-evaluations: The PNPs were given a self-evaluation using the Clinical Teaching Behaviors Inventory (CTBI) (Lee-Hsieh et al., 2016) for evaluation of the clinical teaching behaviors of the preceptor. The CTBI was developed from NP and NGN perceptions of precepting in a Taiwanese context. The CTBI contains 23 NP clinical teaching behaviors in six domains and is a valid and reliable instrument based on confirmatory factor analysis. The overall Cronbach's alpha is .96. These 23 behaviors are scored on a 5-point Likert scale (5 = always, 1 = never), with scores ranging from 23 to 115.
  • NGN evaluations: The NGNs were given the same CTBI for evaluation of their NP's clinical teaching behaviors after being precepted for at least 3 months.
  • Focus groups: Focus group interviews with NPs and NGNs were conducted after completion of the 3-month preceptorship.

Development Stage

Teaching content and materials development was based on the interview data of the NPs and NGNs. Four steps were performed:

  • Portions of the audio recordings were selected, which were incorporated verbatim into the scripts as the authentic voice of NP and NGN experience. Scripts were created for a total of 81 videos in six topics—64 videos using NP experiences and 17 videos using NGN experiences. These 81 videos were made using Voki custom avatars to represent all speakers to protect their identities. The videos, subtitled in Chinese, were compiled using Corel VideoStudio® Pro in WMV format.
  • Ten films were created using the NP and NGN stories showing NP–NGN interaction scenarios.
  • The reflection quizzes in each unit were printed on A4 size paper. The PNPs answered the questions at the end of each topic to enhance retention. Ten minutes were allowed for the quizzes.
  • The materials developed in the first three steps were sent to the expert panel, which reviewed the content, evaluation, and materials. Then, the content was revised according to the recommendations and suggestions of the panel. Tables 13 describe the use of Gagne's nine events of instruction and examples of teaching strategies, examples of audio recordings, and an example of the film for “Building a Learning Atmosphere.”

Topics and Instruction Events of the Nurse Preceptor-Centered Training Program

Table 1:

Topics and Instruction Events of the Nurse Preceptor-Centered Training Program

Examples of Audio Recordings: Building a Learning Atmosphere

Table 2:

Examples of Audio Recordings: Building a Learning Atmosphere

Example of Films:

Table 3:

Example of Films: "Building a Learning Atmosphere"

Implementation Stage

The NPCTP implementation message was posted on the Web sites of four hospitals (in Taipei, Taoyuan, Changhua, and Chiayi) via their e-learning systems. A total of 334 PNPs (i.e., nurses with more than 3 years of clinical experience) from the four teaching hospitals took the NPCTP between June 2015 and March 2016. All 334 PNPs signed consent forms and were informed that the participation would not affect their clinical practice evaluation and that they were free to leave the study at any time. This study was approved by the institutional review boards of all involved hospitals.

Evaluation Stage

Reflection Quizzes. The authors' analysis of these reflection quizzes showed that the 334 PNPs felt they would be good NPs in the scenarios. The majority described that they would build a “friendly and cooperative” learning atmosphere (n = 101); adopt “demonstration and repeated demonstrations” teaching methods in teaching the NGN nursing skills and interventions (n = 138); pay attention to their own “voice and attitude” and “express empathy” when talking to NGNs (n = 73); when the NGN was upset, first, let her cry, then try to find the reasons and provide “concern, support and giving confidence” (n = 104); when they are angry in teaching or work, remind them to be calm and take a deep breath to “adjust emotion” (n = 107). Although the research team cannot know how they actually behave, the results of the PNP self-evaluations and NGN evaluations appear to support these answers.

NPCTP Courses Evaluation. The 334 PNPs completed a course evaluation questionnaire to evaluate their perceptions of the NPCTP and learning experiences. The overall mean scores of the three categories of teaching quality, teaching content, and learning outcome of the NPCTP courses evaluation were 4.59 ± .44, 4.62 ± .45, and 4.42 ± .45, respectively. The highest score of each category was “clearly explained,” “adhered to objectives and professionalism,” and “this course has had a positive effect on my ability to precept new nurses,” respectively.

PNP Self-Evaluations. The PNPs completed the CTBI to evaluate their clinical teaching behaviors at three separate time points: once (T0) before the NPCTP starts, once (T1) after NPCTP was implemented, and once (T2) after the PNPs finished instructing NGNs for 3 months, becoming NPs. All participants filled out the last four digits of their nine-digit identification number on the CTBI questionnaire and returned it to the research assistant for data tracking. Results of a paired t test showed that the overall mean scores for the 23 items of the CTBI of 334 PNPs on T1 (96.47 ± 11.07) were significantly higher than average T0 scores (83.15 ± 12.94) (t = 19.02, p < .001) (Table 4). By the end of June 2016, 54 of 334 PNPs finished the 3-month preceptorship and completed the CTBI again (T2). The overall mean scores for the 23 items of the CTBI of 54 NPs on T0, T1, and T2 were 81.43 ± 12.68, 94.74 ± 11.05, and 90.98 ± 8.28, respectively. Results of the generalized estimating equations test showed that improvement in CTBI of 54 NPs from T0 to T1 and from T0 to T2 was 13.32 (β = 13.32, p < .001) and 9.56 (β = 9.56, p < .001), respectively (Table 5).

�A;Potential Nurse Preceptors' Evaluation of Clinical Teaching Behaviors Before and After the Nurse Preceptor–Centered Training Program (NPCTP) (N = 334)

Table 4:

Potential Nurse Preceptors' Evaluation of Clinical Teaching Behaviors Before and After the Nurse Preceptor–Centered Training Program (NPCTP) (N = 334)

�A;Potential Nurse Preceptors' Evaluation Clinical Teaching Behaviors at Three Time Points by Generalized Estimating Equations Analysis

Table 5:

Potential Nurse Preceptors' Evaluation Clinical Teaching Behaviors at Three Time Points by Generalized Estimating Equations Analysis

NGN Evaluations. Fify-three NGNs used the CTBI to evaluate their NPs' clinical teaching behaviors in June 2016. Both NP and NGN evaluations were collected by the assistant. The NPs were not informed of the results of the NGN evaluations. These results showed that the NGN score (107.21 ± 9.15) was significantly higher than the score the NPs gave themselves (90.98 ± 8.28) (t = 9.63, p < .001) (Table 6).

�A;Comparison of Clinical Teaching Behaviors Between Nurse Preceptors (NP) and New Graduate Nurses (NGN) (N = 107)

Table 6:

Comparison of Clinical Teaching Behaviors Between Nurse Preceptors (NP) and New Graduate Nurses (NGN) (N = 107)

Focus Groups. Invitations were sent to all 54 pairs of NPs and NGNs asking them to participate in the focus group interviews in July 2016. A total of 13 NPs and 11 NGNs participated. For the NPs, the questions included “Please share your experiences of precepting NGNs and your recommendations for the NPCTP courses.” For the NGNs, the questions included “Please share your experiences of learning with your NPs.” Content analysis of the NPs' interviews data showed that (Letters A through M in parentheses below represent one of the 13 NP participants, and letters A through K represent one of the 11 NGN participants, to protect anonymity):

  • Course content is practical: NP (C) said, “They were lots of practical examples…. I have the same experiences as many of these examples when I was working with the NGN.” NP (K) said, “The most useful film for me was the topic of ‘feedback and evaluation,’ there was an NGN conducting physical assessment on a patient with abdominal pain and NP used the [Mini-Clinical Evaluation Exercise] to evaluate her performance. I had the exact the same experience…. Oh, this course is great!”
  • The teaching material is attractive. NP (L) said, “This was the first time I did not fall asleep in the class in a hospital's courses. Watching the authentic films of the preceptor and new nurse interaction felt real. I also listened to lots of authentic videos on how a preceptor is supposed to precept a new nurse, which helped me prepare for how to be a NP.”
  • Empathize with NGNs. Many NPs said they were able to see things from the NGN's point of view. NP (M) said “I would not blame [the] NGN when she made mistakes, I talked to her softly and tried to find out the reasons first, as well as paid attention to her expression and emotion.” The NGN data revealed working in a cooperative and supporting atmosphere. NGN (C) said, “When I am working, my NP often asks if everything is ok…. If I don't get all my work done before the day shift, he always helps me finish.” The NGN data also revealed a passion for teaching: A couple of NGNs described that their NP showed patience in teaching. NGN (B) said, “One day I did not sense my patient's blood pressure drop…. Another time, I forgot how to calculate the dosage of my patient's medication…. My preceptor was still patient and repeated in teaching me, and I felt she was always eager to help me.” However, NGN (K) described her negative learning experiences: “When I perform nursing techniques, I am not as fast as my preceptor but she said ‘You have been working for 3 months.… Could you do it faster…[and] could you do your best?’ I still need more time to practice.…”

Discussion

This research shows how training needs assessment can serve as empirical evidence guiding the development of the NPCTP. Many NP training programs assess preceptor' training needs only from the preceptors' point of view (Chang et al., 2015; Foy et al., 2013). The current study involved input from NPs and NGNs to develop topics, such as guidance skills and emotional management skills, an innovative approach, especially in Taiwan. This learner-centered approach provided the direction for the what and how of the NPCTP. Results indicated that this action plan project not only enhanced NP clinical teaching behaviors but also had a positive impact on both NP and NGN preceptorship experiences.

This study indicates that Taiwan NPs' training needs are similar at the international and national levels (Foy et al., 2013; Haggerty et al., 2013; Lee & Kao, 2012; Whitehead et al., 2013). The scope of NPCTP topics is broader than the required TJCHA topics, which include only teaching strategies, evaluation skills, and interprofessional practice (TJCHA, 2014) and does not address the one-to-one nature of the NP–NGN relationship. The three additional topics of the NPCTP—learning atmosphere, guidance skills, and emotional management—are crucial needs of NGNs during their orientation period (Kang et al., 2016; Tsai & Lee-Hsieh, 2015; Whitehead et al., 2013).

The presentation of NPCTP topics emphasized practical, innovative, authentic, and inspirational teaching approaches (Branch, 2009). This study provides several unique findings. First, the 10 hours of teaching content contains 81 videos based on NP teaching experiences and NGN learning experiences, and 10 NP–NGN interaction scenario films. Hence, the teaching materials were practical rather than theoretical, different from previous studies (Chang et al., 2015; Foy et al., 2013). The NPs said they appreciated these courses, stating, for example, “It [the teaching material] gave lots of practical examples…. I can even just copy them.”

Second, the multiple teaching skills presentation was different from using lecture alone (Bell et al., 2014; Epstein & Carlin, 2012). On the basis of the results of the focus group interviews with the NPs, the current authors thought that using nine instructional events (Gagné, 1985) along with video instruction and reflections would have a strong pedagogical effect. The NPs consistently mentioned the examples of NPs' and NGNs' preceptorship experiences as having the strongest influence in the interviews and reflection quizzes. Some remembered positive examples. However, others remembered negative examples clearly. It appears that the examples functioned as reminders for being good role models for the NGNs. Further, the reflection quizzes were all based on the content of the courses, reinforcing their influence.

Third, the authors recruited and trained 334 PNPs in this study. Because it was the off-season for recruiting new graduates, only 54 finished instructing NGNs for 3 months and became NPs. The results indicated that the NPCTP enhances nurse preceptor clinical teaching behaviors. Of note, after the implementation of the NPCTP in July 2016, the nurse education division of the four cooperating hospitals requested the research team give them the permission to use the videos and teaching films as teaching materials for their NP preparation program.

Four, the NGNs gave a higher score to the NPs' clinical teaching behaviors than the NPs themselves. This unique finding may be explained by the NGNs having worked 3 months and having passed their trial period. Therefore, they may view their NPs as colleagues and thus gave them higher scores, whereas those who might have given lower scores had left the work unit. Further, many studies argue that an ineffective NP preparation program generates enormous stress for the NPs and NGNs during the NP–NGN preceptorship (Chang et al., 2015; Dawson et al., 2014; Tsai et al., 2014). In this study, the NGNs scored all six domains higher than the NPs scored themselves. The 53 NGNs who completed the CTBI all recommended that their NP continue precepting incoming NGNs. This phenomenon shows that the NPCTP appears to be an effective NP training program. As one NP said in the focus groups, “These courses really influenced the way I interacted with my litter sister…. I became more empathic with her.”

Recommendations and Conclusion

Based on the findings of this study, the authors' recommendations are as follows. First, an NP training program should involve input from NPs and NGNs before course design begins. Second, the scope of TJCHA should be expanded to issues such as teaching affection, guidance skills, and emotion management. Third, the content of NP training courses must be made less theoretical and more practical and include more clinical teaching scenarios. Fourth, the use of diverse teaching methods, such as videos, films, asking questions, group discussion, and reflections, could facilitate NP interest and motivation in learning.

This research has several limitations. It was conducted in Taiwan and addresses local needs and conditions. Future research should replicate this research in other cultures and use a two-group quasi-experimental research design to evaluate NP clinical teaching behaviors.

NPs are effective in ensuring successful NGN's orientation. This study assessed the training needs of key participants—NPs and NGNs—to develop a “NP-centered” training program. This evidence-based research approach can be used to enhance NP training programs in teaching hospitals in Taiwan.

References

  • Adlam, K.A., Dotchin, M. & Hayward, S. (2009). Nursing first year of practice, past, present and future: Documenting the journey in New Zealand. Journal of Nursing Management, 17, 570–575. doi:10.1111/j.1365-2834.2008.00932.x [CrossRef]
  • Ali, W.G. (2012). Caring and effective teaching behavior of clinical nursing instructors in clinical area as perceived by their students. Journal of Education and Practice, 3(7), 15–26.
  • Altschuld, J.W. & Kumar, D.D. (2010). Needs assessment: An overview. Thousand Oaks, CA: Sage.
  • Bell, S.K., Pascucci, R., Fancy, K., Coleman, K., Zurakowski, D. & Meyer, E.C. (2014). The educational value of improvisational actors to teach communication and relational skills: Perspectives of interprofessional learners, faculty, and actors. Patient Education and Counseling, 96, 381–388. doi:10.1016/j.pec.2014.07.001 [CrossRef]
  • Branch, R.M. (2009). Instructional design: The ADDIE Approach. New York, NY: Springer.
  • Broadbent, M., Moxham, L., Sander, T., Walker, S. & Dwyer, T. (2014). Supporting bachelor of nursing students within the clinical environment: Perspectives of preceptors. Nurse Education in Practice, 14, 403–409. doi:10.1016/j.nepr.2013.12.003 [CrossRef]
  • Chang, C.C., Lin, L.M., Chen, I.H., Kang, C.M. & Chang, W.Y. (2015). Perceptions and experiences of nurse preceptors regarding their training courses: A mixed method study. Nurse Education Today, 35, 220–226. doi:10.1016/j.nedt.2014.08.002 [CrossRef]
  • Dawson, A.J., Stasa, H., Roche, M.A., Homer, C.S. & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies. BMC Nursing, 13(11), 1–10. doi:10.1186/1472-6955-13-11 [CrossRef]
  • Edwards, D., Hawker, C., Carrier, J. & Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies, 52, 1254–1268. doi:10.1016/j.ijnurstu.2015.03.007 [CrossRef]
  • Epstein, I. & Carlin, K. (2012). Ethical concerns in the student/preceptor relationship: A need for change. Nurse Education Today, 32, 897–902. doi:10.1016/j.nedt.2012.03.009 [CrossRef]
  • Feng, M.C., Chen, Y.M., Wu, L.K. & Wu, L.C. (2011). Perceived stress and coping strategies of newly graduated nurses. Journal of Nursing and Healthcare Research, 7, 98–107. doi:10.6225/JNHR.7.2.98 [CrossRef]
  • Foy, D., Carlson, M. & White, A. (2013). RN preceptor learning needs assessment. Journal for Nurses in Professional Development, 29, 64–69. doi:10.1097/NND.0b013e318287aa12 [CrossRef]
  • French, B.M. & Greenspan, M. (2014). The preceptored clinical experience. In Bradshaw, M. J. & Lowenstein, A.J. (Eds.), Innovative teaching strategies in nursing and related health professions (pp. 417–436). Burlington, MA: Jones & Bartlett Learning.
  • Gagné, R.M. (1985). The conditions of learning and theory of instruction. New York, NY: Holt, Rinehart & Winston.
  • Gustafson, K.L. & Branch, R.M. (2011). What is instructional design? In Reiser, R.A. & Dempsey, J.V. (Eds.), Trends and issues in instructional design and technology (3rd ed., pp. 16–25). Boston, MA: Pearson.
  • Haggerty, C., Holloway, K. & Wilson, D. (2013). How to grow our own: An evaluation of preceptorship in New Zealand graduate nurse programmes. Contemporary Nurse, 43, 162–171. doi:10.5172/conu.2013.43.2.162 [CrossRef]
  • Halabi, J.O., Abdalrahim, M.S., Persson, G.L., Hedemalm, A. & Lepp, M. (2012). The development of a preceptor training program on clinical nursing education in Jordan in collaboration with Sweden. The Journal of Continuing Education in Nursing, 43, 135–144. doi:10.3928/00220124-20111115-04 [CrossRef]
  • Hilli, Y., Melender, H.L., Salmu, M. & Jonsén, E. (2014). Being a preceptor—A Nordic qualitative study. Nurse Education Today, 34, 1420–1424. doi:10.1016/j.nedt.2014.04.013 [CrossRef]
  • Horton, C.D., DePaoli, S., Hertach, M. & Bower, M. (2012). Enhancing the effectiveness of nurse preceptors. Journal for Nurses in Staff Development, 28(4), e1–e7. doi:10.1097/NND.0b013e31825dfb90 [CrossRef]
  • Kang, C.M., Chiu, H.T., Lin, Y.K. & Chang, W.Y. (2016). Development of a situational initiation training program for preceptors to retain new graduate nurses: Process and initial outcomes. Nurse Education Today, 37, 75–82. doi:10.1016/j.nedt.2015.11.022 [CrossRef]
  • Kovner, C.T., Brewer, C.S., Fatehi, F. & Jun, J. (2014). What does nurse turnover rate mean and what is the rate?Policy, Politics, & Nursing Practice, 15(3–4), 64–71. doi:10.1177/1527154414547953 [CrossRef]
  • Lee, Y.C. & Kao, Y.H. (2012). Clinical nursing preceptor educational training needs: An assessment. Journal of Nursing and Healthcare Research, 8, 106–116. doi:10.6225/JNHR.08.2.106 [CrossRef]
  • Lee-Hsieh, J., O'Brien, A., Liu, C.Y., Cheng, S.F., Lee, Y.W. & Kao, Y.H. (2016). Development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors' and new graduate nurses' perceptions of precepting. Nurse Education Today, 38, 107–114. doi:10.1016/j.nedt.2015.12.005 [CrossRef]
  • Lincoln, Y.S. & Guba, E.G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
  • McDonald, W.J. (2005). Council of medical specialty societies: Committed to continuing medical education reform. Journal of Continuing Education in the Health Professions, 25, 144–150. doi:10.1002/chp.21 [CrossRef]
  • Taiwan Joint Commission on Hospital Accreditation. (2014). Accreditation and certification. Retrieved from http://1060335.idun.com.tw/
  • Tsai, Y.M. & Lee-Hsieh, J. (2015). Reflection on nurse preceptor training courses: The experiences of nurse preceptors and preceptees. The Journal of Nursing, 62(3), 49–56. doi:10.6224/JN.62.3.49 [CrossRef]
  • Tsai, Y.M., Lee-Hsieh, J., Turton, M.A., Li, S.Y., Tseng, H.L., Lin, H.C. & Lin, H.L. (2014). Nurse preceptor training needs assessment: Preceptor and new graduate views. The Journal of Continuing Education in Nursing, 45, 497–505. doi:10.3928/00220124-20141023-01 [CrossRef]
  • Warholak, T.L. (2009). Preceptor perception of pharmacy student team quality assurance projects. American Journal of Pharmaceutical Education, 73(3), 1–6. doi:10.5688/aj730347 [CrossRef]
  • Whitehead, B., Owen, P., Holmes, D., Beddingham, E., Simmons, M., Henshaw, L. & Walker, C. (2013). Supporting newly qualified nurses in the UK: A systematic literature review. Nurse Education Today, 33, 370–377. doi:10.1016/j.nedt.2013.01.009 [CrossRef]
  • Yang, F.C., Ou, W.J. & Tang, C.C. (2011). Effectiveness of a clinical preceptor program in a medical center. VGH Nursing, 28(1), 8–16.

Topics and Instruction Events of the Nurse Preceptor–Centered Training Program

Course Topic/Instruction Event Building a Learning Atmosphere Curriculum Design and Teaching Strategy Communication and Interprofessional Practice Evaluation and Feedback Guidance Skills Emotional Management Skills
1. Gain attention Ask questions Play five NGN audio recordings and ask questions Play one film and ask questions Ask questions Ask questions Ask questions and play one film
2. Describe the goal Describe objectives Describe objectives Describe objectives Describe objectives Describe objectives Describe objectives
3. Stimulate recall of prior knowledge Play four NGN audio recordings and ask questions Ask questions Ask questions Play one NGN and one NP audio recordings and ask questions Play one NP and four NGN audio recordings and ask questions Play one NP audio recording and ask questions
4. Present the material to be learned Lecture and play two NGN and 14 NP audio recordings Lecture and play 18 NP audio recordings Lecture and play three NP and one NGN audio recordings Lecture and play three NP audio recordings Lecture and play one NP audio recording and ask questions Lecture and ask questions
5. Provide guidance for learning Play four NP audio recordings and one film Play one film Scenario exercise and role-play Play one film and scenario exercise Play eight NP and one NGN audio recordings and one film Case study and play seven NP audio recordings
6. Elicit performance “practice” Play two NP audio recordings and share experiences Group discussion and presentation Group discussion and share experiences Case study and group discussion Case study and group discussion and share experiences Case study and group discussion and presentation
7. Provide informative feedback Instructor provides feedback Instructor provide feedback Presentation and instructor provide feedback Play a film and group discussion and presentation Group presentation and instructor provide feedback Instructor provides feedback
8. Assess performance test Ask questions and respond Ask questions and respond Ask questions and respond Ask questions and respond Ask questions and respond Ask questions and respond
9. Enhance retention and transfer Reflection quiz Reflection quiz Reflection quiz Reflection quiz Reflection quiz Reflection quiz

Examples of Audio Recordings: Building a Learning Atmosphere

Theme or Subtheme Selected Quote
Learning atmosphere was warm and caring Preceptor B: “We must offer a warm organizational culture to the little sisters, as if they were family. We take the initiative to warmly watch over them like mother hens, to make them feel at ease as a member of the team…. Sometimes after work we will take turns going out to dinner and karaoke with the little sisters.”
Learning atmosphere was collaborative and supporting New nurse F: “When I am working, the big sisters all ask if everything is ok…. If I don't get all my work done before it is time to go, they help me finish.”
Struggle alone New nurse M: “I had a patient to prep for [the operation department], another for transfusion, and another with family members asking questions. I requested help from another nurse, but she said 'Care for your own patients! Everyone is busy!' [That] made me really sad.”

Example of Films: “Building a Learning Atmosphere”

Scenario Dialogue
Scenario 1: New graduate nurse (NGN) Little Yu graduated in June and began working at the hospital in July. After 3 days of orientation, she reported to the cardiovascular unit begin her new job. Little Yu was anxious and obviously tense and afraid. Hsin-yu, her preceptor (P), got Little Yu's background information. Before Little Yu reported to the unit, Hsin-yu made posters with Little Yu's name, university, photograph, interests, and words of welcome before she began work to create a warm, welcoming atmosphere. P: Are you Little Yu?
Little Yu (NGN): Yes! How are you?
P: Welcome to our team! I am your preceptor, Hsin-yu. You can call me Hsin-yu. In this unit, everyone already knows about you! Please introduce yourself a little more.
NGN: Ok, I just graduated this year. You can call me Little Yu. I never went to a heart-related unit before during my internship, so I am pretty nervous.
P: It's okay! In a new environment, everyone is nervous. Before I came to this unit, I was really nervous. Just take it slowly. I'll share some of the internship experiences we've had at this unit with you. Then gradually you'll become able to take care of patients on your own. Let's work on it together!
NGN: Ok! Thanks so much.
Scenario 2: After getting off work, Hsin-yu takes the initiative to ask how Little Yu is adapting to the situation. P: Little Yu! Are you living in the hospital's dorm?
NGN: Yes!
P: Where does your family live?
NGN: They live in Kaohsiung.
P: So, have you gotten used to dorm life?
NGN: Well, I stayed in the dorm. I don't have much of a chance to meet people. One of my roommates arrived at the same time, but I haven't had a chance to meet her yet.
P: Yes, because everyone takes a rest at different times (three shifts). It takes everyone a while to get used to the break cycle. Do you know anyone who started here at the same time you did?
NGN: Several of my former classmates arrived with me, but they are all in different units.
P: You didn't come to this hospital during your internship, so you're probably not familiar with the area around it, right?
NGN: I don't know a thing about it., so I just eat in the downstairs cafeteria every day.
P: Give me a minute, I'll take you out to eat, and then take you by the places to eat, delicious and cheap! Later, I'll take you to a store where you can get household necessities.
NGN: Great!
P: This is my cell number and my Facebook® [identification]. If you need me, just get in touch with me anytime. Sometimes I won't answer the phone, but if I am free, I will answer a message right away.
NGN: Wonderful! Can I have your LINE ID? [LINE is a social network popular in Taiwan.]
P: Sure! [Adds her on LINE] At the beginning you must get used to many different places, so you need to have a calm and peaceful life in order to focus on learning new things in our jobs. Let's work together! Come on, let's go eat!
NGN: Great!

Potential Nurse Preceptors' Evaluation of Clinical Teaching Behaviors Before and After the Nurse Preceptor–Centered Training Program (NPCTP) (N = 334)

CTBI Domain (No. of Items) Mean (SD) Paired t Test

Before NPCTP After NPCTP
Committing to teaching (4) 15.03 (2.35) 16.87 (2.02) t(333) = 14.37***
Building a learning atmosphere (5) 17.99 (3.12) 20.78 (2.66) t(333) = 16.17***
Using appropriate teaching strategies (5) 17.76 (3.33) 20.87 (2.63) t(333) = 16.99***
Guiding interprofessional communication (3) 10.47 (2.10) 12.49 (1.67) t(333) = 16.43***
Providing feedback and evaluation (3) 10.70 (2.06) 12.62 (1.68) t(333) = 16.13***
Showing concern and support (3) 11.21 (2.19) 12.84 (1.75) t(332) = 13.99***
Total 83.16 (15.15) 96.47 (12.41) t(332) = 19.02***

Potential Nurse Preceptors' Evaluation Clinical Teaching Behaviors at Three Time Points by Generalized Estimating Equations Analysis

Outcome of Variable β SE 95% Wald Confidence Interval p Value

Lower Upper
Intercept 81.43 1.71 78.08 84.78 <.001
T0 (n = 54) 0
T1(n = 54) 13.32 1.70 9.98 16.65 <.001
T2(n = 54) 9.56 1.73 6.17 12.95 <.001

Comparison of Clinical Teaching Behaviors Between Nurse Preceptors (NP) and New Graduate Nurses (NGN) (N = 107)

Clinical Teaching Behaviors Inventory Domain (No. of Items) Mean (SD) Independent t Test

NP (n = 54) NGN (n = 53)
Committing to teaching (4) 16.33 (1.94) 19.30 (1.23) t(105) = 9.42***
Building a learning atmosphere (5) 19.72 (2.25) 22.70 (2.51) t(105) = 6.46***
Using appropriate teaching strategies (5) 19.56 (1.72) 23.36 (2.09) t(105) = 10.29***
Guiding interprofessional communication (3) 11.67 (1.10) 14.08 (1.34) t(105) = 10.17***
Providing feedback and evaluation (3) 11.81 (1.29) 14.21 (1.36) t(105) = 9.33***
Showing concern and support (3) 11.89 (1.95) 13.57 (1.92) t(105) = 4.49***
Total 90.98 (10.25) 107.21 (10.45) t(105) = 9.63***

Save
Save
Authors

Dr. Lee is Supervisor, Department of Nursing, Changhua Christian Hospital, Changhua; Ms. Lin is Supervisor, Department of Nursing, Linkou Chang Gung Memorial Hospital, Linkou; Ms. Tseng is Head Nurse, Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi; Ms. Tsai is Head Nurse, Department of Nursing, Mackay Memorial Hospital; and Ms. Lee-Hsieh is Professor, Graduate Institute of Allied Health Education, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

This study was supported by the Taiwan Ministry of Science and Technology through grant MOST 102-2511-S-227-001-MY3.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank all participants for their assistance and openness.

Address correspondence to Jane Lee-Hsieh, RN, MSN, Professor, Graduate Institute of Allied Health Education, National Taipei University of Nursing and Health Sciences, 365 Ming-te Rd., Peitou District, Taipei 11219, Taiwan, R.O.C.; e-mail: hsiehjane@ntunhs.edu.tw.

Received: August 15, 2016
Accepted: November 10, 2016

10.3928/00220124-20170418-07

Advertisement

Sign up to receive

Journal E-contents
Advertisement