Journal of Nursing Education

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Effect of Pregraduate Preceptorship Experience on Development of Adaptive Competencies of Baccalaureate Nursing Students

Heather K Spence Laschinger, PhD, RN; Elsie MacMaster, MScN, BScN, RN

Abstract

ABSTRACT

Kolb's (1984) theory of experiential learning was used as a framework to study 50 baccalaureate nursing students' perceptions of the contributions of a senior preceptorship experience to the development of adaptive competencies. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both peopleoriented and scientific skills in nursing. The preceptorship had a significant impact on most learning competencies. Significant increases occurred in competencies considered not important for nursing by students prior to the experience, e.g., assimilative competencies such as testing theories and ideas, and accommodative competencies such as leading and influencing others. These results support the notion of further research of nursing learning environments from the experiential learning perspective.

Abstract

ABSTRACT

Kolb's (1984) theory of experiential learning was used as a framework to study 50 baccalaureate nursing students' perceptions of the contributions of a senior preceptorship experience to the development of adaptive competencies. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both peopleoriented and scientific skills in nursing. The preceptorship had a significant impact on most learning competencies. Significant increases occurred in competencies considered not important for nursing by students prior to the experience, e.g., assimilative competencies such as testing theories and ideas, and accommodative competencies such as leading and influencing others. These results support the notion of further research of nursing learning environments from the experiential learning perspective.

Introduction

University nursing faculty are faced with the challenge of assuring the quality of graduates from baccalaureate nursing (BSN) programs with regard to their effective functioning in health care settings. BSN programs are based on the assumption that such an educational background fosters the development of a variety of competency types (both conceptual and practical) that would enable graduates to adapt to changing work environments and to situations as their careers progress. Professional nursing education programs attempt to provide learning environments that foster the development of these competencies. The concept of a pregraduate preceptorship experience is a popular teacWng-learning strategy that facilitates the transition from the protected environment of supervised clinical experiences in nursing schools to independent nursing practice. However, as Scheetz (1989) and Myrick (1986) note, few reports of empirical investigations of the effects of these preceptorship programs exist in the literature.

In this study, the contribution of a senior preceptorship program to the development of different types of learning competencies in BSN students was examined from Kolb's (1984) experiential learning theory (ELT) perspective.

Experiential Learning Theory

KoIb (1984) describes a four-stage cycle of learning that involves four modes of learning. Learning begins with immediate concrete experience (CE), which provides the basis for reflective observation (RX)) and subsequent construction of a theoretical explanation for that experience (abstract conceptualization [AC]). This explanation is then used to derive hypotheses about appropriate actions to be used in other situations (active experimentation [AE]). These actions in turn lead to new concrete experiences to be reflected upon and the cycle continues.

Table

FIGURE 1Adaptive Competencies Related to Learning Style*

FIGURE 1

Adaptive Competencies Related to Learning Style*

KoIb (1984) has found that members of different disciplines tend to have learning styles that reflect the learning competencies most necessary for effective functioning in the discipline (referred to by KoIb as the "environmental press" of disciplinary learning environments). For example, engineers were found to have predominantly abstract/active learning styles and engineering learning environments tended to have a symbolic, problem-solving environmental press. In contrast, social workers had concrete/reflective learning styles and social work learning environments were predominantly concrete/ affective. Laschinger (1986) and Laschinger and Boss (1989) found that nursing students had predominantly concrete learning styles and that nursing learning environments were perceived to be predominantly concrete.

In the theory, KoIb (1984) describes a typology of four learning styles and a corresponding typology of four learning environments that reflect the amount of emphasis (environmental press) placed on learning competencies associated with each of the four stages or modes of the learning cycle described earlier. People with "diverger" learning styles emphasize experiencing of concrete situations. The corresponding divergent/affective learning environment demands the use of competencies associated with this mode (Figure 1). Individuals with "assimilato!-" learning styles excel in constructing theoretical explanations of concrete events. The corresponding perceptual environment emphasizes reflective observation and perspective taking skills. Individuals with "converger" learning styles prefer to apply theoretical approaches to practical situations. The corresponding symbolic learning environment emphasizes abstract conceptualization skills. Finally, people with "accommodator* learning styles are good at carrying out plans and getting things done but are less concerned with having a theoretical rationale for their action. Behavioral learning environments emphasize action-taking in real life situations. KoIb et al. (1981) developed the Adaptive Competency Profile (ACP) to describe learners' personal learning competencies and the Environmental Press Questionnaire (EPQ) to classify learning environments.

Fry and KoIb (1979) suggest that any learning environment has different degrees of orientation toward each of the four learning modes but that one orientation tends to predominate. Fry (1978) observed consistent patterns of learning mode combinations in architecture learning environments. Environments combining perceptual and symbolic orientations created an "inquiry climate." Emphasis is on understanding why things happen and on theory construction from concrete events. A "mastery climate" is created when the symbolic and behavioral orientations are combined. Emphasis is on problemsolving in real life situations. A "simulative climate* is created when behavioral and affective orientations are combined with emphasis placed on providing actual experience in the professional work role. Although Fry did not describe an affective/perceptual climate, it is possible that such a combination would create an "aesthetic appreciation* climate with emphasis on the subjective appreciation and valuing of concrete experiences.

KoIb (1984) maintains that current professional education programs focus on the development of core learning competencies essential for beginning role functions at the expense of other types of learning competencies making the transition to changing job roles throughout careers difficult for graduates. KoIb recommends use of a variety of learning environments in professional education programs to develop a full range of learning competencies necessary for lifelong learning and adaptation to changing work environments.

KoIb et al. (1981) developed a methodology for measuring personal learning style and the environmental press of different learning environments in commensurate terms. This approach permits diagnosis of gaps between an individual's level of skill on competencies associated with each learning mode and his or her perception of the importance of these competencies for successful functioning in a given environment. It provides a basis for designing individualized learning experiences to promote the development of learning competencies that need improvement. In a series of studies with engineering and social work populations, Fry (1981) found that the methodology successfully differentiated between engineering and social work learning environments and between the learning orientations of engineering and social work students.

Figure 2. Pre-/post-preceptorship mapping of gaps between personal levels of skill and perceived importance ratings of adaptive competencies. From David A. KoIb, Experiential Learning, 1984, p. 96. Adapted by permission of Prentice Hall, Englewood Cliffs, NJ.

Figure 2. Pre-/post-preceptorship mapping of gaps between personal levels of skill and perceived importance ratings of adaptive competencies. From David A. KoIb, Experiential Learning, 1984, p. 96. Adapted by permission of Prentice Hall, Englewood Cliffs, NJ.

The notion of person-environment match/mismatch was studied by Fry and Sims (1981) who developed the concept of mapping environmental press perceptions and selfratings of adaptive competencies using the Competency Circle (Figure 2). In the diagram, ACP and EPQ item scores are mapped on the spokes of the circle with higher scores situated near the perimeter. A profile of learners' competency levels is configured by joining points on each spoke in the diagram providing a visual representation of gaps between self-ratings of personal learning competencies and perceptions of their importance for effective job performance.

Laschinger (1986, 1992) and Laschinger and Boss (1983) found construct validity for this methodology in studies of BSN students. Consistent with expectations of members of a human service profession, nursing students rated themselves higher on concrete/active competencies than abstract competencies. Similarly, general learning environments in nursing were perceived to have a strong concrete environmental press.

Preceptorship programs in nursing education

Nursing education programs have always included a variety of learning environments to provide both theoretical and behavioral approaches to learning to nurse. In recent years, a learning experience in the final year in which students work with preceptors in a variety of nursing settings has been incorporated into many nursing education programs. The rationale for the preceptor experience is to provide students with an intensive reality-based clinical experience to facilitate transition into the real world of nursing.

Reports of empirical research on the effects of clinical preceptorships are rare in the literature. In a pre-/posttest study, Dobbs (1989) studied the socialization effects of a senior preceptorship experience and found that BSN students (n = 103) showed significant positive changes in role expectations and self-image as a nurse following their preceptorship experience. Students who identified practicing nurses as role models showed a significant decrease in role deprivation scores. The authors concluded that the preceptorship experience contributed to lessening the degree of reality shock experienced by nurses entering the work force.

Scheetz (1989) compared clinical competencies of BSN students who participated in a summer preceptorship experience to those who worked as nursing assistants in nonteaching clinical settings. Students in the preceptorship program demonstrated significantly greater increases in clinical competencies such as problem-solving, application of theory to practice, and psychomotor skills, than those who worked as nursing assistants. The authors suggest that preceptorship experiences are effective means of increasing clinical competence of BSN students and may reduce orientation needs for new BSN graduates entering the system.

From the experiential learning perspective, a preceptorship experience would be expected to emphasize the use of learning competencies most useful for successful functioning in the real world of nursing. Competencies pivotal to the practice of nursing would be modeled by nurse preceptors and imitated by students working with them. KoIb (1984) maintains that competencies frequently used in actual nursing situations reflect the predominant environmental press and that exposure to such environments should contribute to development of pivotal learning competencies. Student perceptions of the contributions of the preceptorship experience to the development of different learning competencies described in ELT are of interest to nurse educators for practical curriculum development purposes and for theoretical development and testing of ELT in the nursing population.

Objectives of the Study

* To compare student perceptions of the environmental press of actual nursing practice environments prior to and following a senior preceptorship experience.

* To compare student self-ratings of skill on learning competencies described in experiential learning theory prior to and following a senior preceptorship experience.

Method

A convenience sample of senior students of a Canadian four-year basic BSN program (rc = 50) was selected to explore research questions derived from Kolb's (1984) theory. Since this study was exploratory in nature, one school of nursing was considered appropriate to ensure relative homogeneity of student experiences regarding curricular focus, organizational enmate and culture, and clinical learning opportunities.

With the permission of the dean of nursing and faculty members, students were invited to participate in the study during class time. Students were assured of the anonymity of their responses and were asked to place the last four numbers of their student numbers on the questionnaires to permit matching of pre-/posttest responses. Students returned completed questionnaires to the researcher in sealed envelopes. The same procedure was used for collecting postpreceptorship data. The rate of student participation was 75% overall although only 20 valid cases could be used for pre-/post-paired t tests of ACP/EPQ scores. Some students either missed class on one of the two data collection sessions or did not complete all items on the measures used to compare the effects of the preceptorship experience. However, due to the exploratory nature of the study, it was decided to proceed with data analysis as a basis for planning a future more definitive study.

The design of the study allowed comparisons prior to and following the senior preceptorship experience on measures of ACP and EPQ of nursing learning environments.

Instrumentation

All senior students participated in a 12-week preceptorship in the final term of their fourth year. Students were given a choice of their preferred clinical population for this experience and faculty arranged appropriate placements within local clinical agencies. Students were assigned on a one-to-one basis to graduate nurses working in selected clinical settings. Students were placed on the same rotation as their preceptor to facilitate students' understanding of the graduate role. The minimum clinical time for this experience was 288 hours (usually 24 hours per week). Students created their own learning contacts with input from their faculty advisors and preceptors. The conditions of these contracts were congruent with the overall course objectives for the experience. Faculty members served as resources for both students and preceptors, but clinical contact with students was minimal during the three-month experience. This strategy was employed to provide students with a sense of independence in the execution of their upcoming roles as beginning practicing nurses.

Two instruments developed by KoIb et al. (1981), the ACP and the EPQ, were completed by the nursing students.

With the ACP, an alternative measure of learning style to Kolb's (1976) Learning Style Inventory (LSI), subjects rate their levels of skill on each of 20 competencies on a seven-point Likert scale. These items are used to describe a personal profile of learning competencies. Mean scores on five competencies theoretically related to each learning mode are summed and averaged to produce a score indicative of individuals' perceived levels of skill on each learning mode (see Figure 1 for competencies associated with each mode). KoIb et al. (1981) established construct validity of the instrument by correlating ACP and LSI modal scores. Significant correlations in the hypothesized direction provided evidence of construct validity. A factor analysis of the items resulted in clusters of competencies representative of the four learning styles. Laschinger and Boss (1983) reported alpha reliability estimates for ACP subscales between .67 and .82. In the current study, alpha reliability coefficients for the four learning style as measured by the ACP ranged from 0.69 to 0.80.

Table

TABLEACP and EPQ Scores of Senior Nursing Students Pre-/Post-Preceptorship

TABLE

ACP and EPQ Scores of Senior Nursing Students Pre-/Post-Preceptorship

The EPQ was designed to measure environmental press perceptions of learning environments. It was developed from the ACP and is described as a commensurate measure of environmental press. Respondents rate the importance of each of the 20 competencies for successful functioning in a designated learning environment on a seven-point Likert scale. EPQ scores are computed by the same method used for the ACP. KoIb et al. (1981) found the EPQ to be a useful and valid method of describing environmental press in engineering and social work. Factor analyses conducted on environmental press measures resulted in clusters of items in patterns consistent with those predicted from experiential learning theory. EPQ scores were found to discriminate between social work and engineering environments as perceived by members of these professions. As with the ACP, no reliability estimates were reported by KoIb et al. In this study, alpha reliability coefficients for the four environmental press scores ranged from 0.68 to 0.79, similar to those reported by Laschinger and Boss (1989).

Results

Student mean scores on individual items on the ACP and EPQ scales before and after the preceptor experience are presented in the Table. Differences in pre-/postpreceptorehip scores reflect students' perceptions of the effects of the senior preceptorship experience on their self-ratings of skill on adaptive competencies and their perceptions of the importance of these competencies for success in nursing.

As can be seen in the Table, students rated themselves higher on all competencies (ACP scores) following the preceptorship experience. Significant increases were observed on most competencies. The largest pre-/postdifferences were active or accommodative competencies such as seeking and exploiting opportunities and influencing and leading others. Other large differences were self-ratings of skill levels on assimilative competencies such as testing theories and experimenting with new ideas.

Changes in perceptions of the importance of adaptive competencies for success in nursing (EPQ scores) were of lower magnitude (Table). The largest differences were in perceived importance of accommodative competencies, in particular the importance of leading and influencing others and seeking and exploiting opportunities. Other significant pre-/post-differences were the perceived importance of experimenting with new ideas, testing theories and ideas, and creating new ways of doing things.

In Figure 2, the gaps between students' self-ratings of skill on adaptive competencies and their perceived importance to nursing are mapped on the Competency Circle to illustrate differences in person-environment fit before and after the preceptorship experience. As can be seen in Figure 2, there are noticeably smaller gaps between self-ratings on adaptive competencies and perceptions of their importance following the preceptorship experience. In addition, scores on individual ACP and EPQ items were higher following the preceptorship experience which is reflected by the outward expansion of the profile mapped on the Competency Circle in Figure 2. Significant differences were found in most pre-/post-difference scores (EPQ-ACQ scores).

Discussion

The results of this study suggest that the preceptorship experience was perceived to have significant effects on senior students' adaptive competency development and plays a role in improving person-environment fit for newcomers to the profession. The type of competencies most dramatically affected were those consistent with predictions of ELT. If actual nursing environments have a predominantly active, concrete press, then it would be expected that working with experienced practitioners in these environments would result in increased skill in active, concrete accommodative skills. In addition, the preceptor experience involves the student in the experiential learning cycle described by KoIb (1984) in a holistic manner that is purported to result in improved personenvironment fit. The results of this exploratory study appear to support Kolb's contentions and suggest further more rigorous research from this perspective.

Also consistent with Kolb's (1984) theory is the finding that students rated abstract competencies lower in importance for success in nursing and rated themselves significantly lower on these skills than on others. This is consistent with earlier findings in research on nursing students (Laschinger, 1986, 1987) and research on social workers (KoIb et al., 1981; Sims, 1983). KoIb (1984) maintains that the environmental press of human service disciplines is predominantly concrete and that abstract competencies are less developed since they are not reinforced in practice settings. Several nurse authors (Meléis & Jennings, 1989; Stevens, 1983; Young & Hayne, 1988) have noted this tendency in nursing learning environments. It is interesting to note that in this study, students felt their abstract skills improved in the preceptorship experience, suggesting that they were able to use the theory and conceptual knowledge gained in the classroom in the real world of nursing practice.

The large perceived change in leadership competencies such as leading and influencing others and seeking and exploiting opportunities following the preceptorship experience is a valuable outcome of this learning experience. In research on BSN students' adaptive competencies and environmental press perceptions of nursing learning environments, Laschinger (1986, 1987) found that students rated themselves significantly lower on these competencies than others. Given the importance of such competencies to the development of autonomous professional practitioners, it was encouraging to find that students in this study perceived both an increase in their levels of skill on these competencies and an increase in their ratings of the importance of these competencies for successful nursing practice.

Conclusion

The findings in this exploratory study suggest that the preceptorship experience had a significant impact on the development of senior students' adaptive competencies as described in ELT. Due to the small sample size, the generalizability of these findings are limited but further research from this perspective seems warranted. Studies with larger more representative samples are needed to replicate the results of this study. A study comparing the adaptive competency self-ratings of graduating BSN students who have and have not been exposed to a senior preceptorship experience would be valuable.

ELT appears to be a useful way of studying the impact of learning experiences in nursing. The methodology designed by KoIb et al. (1981) provides a way of identifying competencies that need to be developed and a means to assess perceptions of changes in levels of skill on different competencies over time. Such a methodology could be the basis for planning learning experiences by structuring learning environments that emphasize the use of a variety of competencies. Kolb's notion of environmental press could be used as a way of assessing perceived learning demands of different learning environments in nursing.

Implications for Nursing

Scheetz (1989) notes that research on the development of competence in BSN students is needed to demonstrate the effectiveness of BSN education. If the inclusion of senior preceptorship experiences in these programs can be shown to have a significant impact on the development of competencies in BSN students, others will have empirical support for revising their curricula to include preceptorship experiences. Scheetz observed that while many anecdotal reports of the effectiveness of preceptorship programs exist in the literature, few empirical investigations have been reported. This exploratory study adds to our knowledge of students' perceptions of the effects of a pregraduation preceptorship experience from the ELT perspective. Further research is recommended to expand nurse educators' understanding of learning experiences that facilitate the transition from student to beginning practitioner in nursing practice.

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FIGURE 1

Adaptive Competencies Related to Learning Style*

TABLE

ACP and EPQ Scores of Senior Nursing Students Pre-/Post-Preceptorship

10.3928/0148-4834-19920601-07

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