Journal of Nursing Education

Major Article 

Pursuing Improvement in Clinical Reasoning: Development of the Clinical Coaching Interactions Inventory

Mary Ann Jessee, PhD, RN; Christine A. Tanner, PhD, RN, FAAN

Abstract

Background:

Clinical coaching has been identified as a signature pedagogy in nursing education. Recent findings indicate that clinical coaching interactions in the clinical learning environment fail to engage students in the higher order thinking skills believed to promote clinical reasoning.

Method:

The Clinical Coaching Interactions Inventory (CCII) was based on evidence of supervisor questioning techniques, the Tanner clinical judgment model, Bloom's Taxonomy, and simulation evaluation tools. Content validity was established with expert assessment, student testing for clarity, and calculation of scale–content validity index/average (S-CVI/Ave). Reliability was established with Kuder-Richardson Formula 20 (KR-20).

Results:

CVI (S-CVI/Ave) was .91, and KR-20 was .70. The CCII identified differences in clinical coaching behaviors in university faculty supervisors and staff nurse preceptor supervisors.

Conclusion:

The CCII advances the measurement of clinical coaching interactions from qualitative to quantitative. Ultimately, results from use of this inventory may facilitate the design of prelicensure clinical coaching strategies that promote the improvement of students' clinical reasoning skill. [J Nurs Educ. 2016;55(9):495–504.]

Abstract

Background:

Clinical coaching has been identified as a signature pedagogy in nursing education. Recent findings indicate that clinical coaching interactions in the clinical learning environment fail to engage students in the higher order thinking skills believed to promote clinical reasoning.

Method:

The Clinical Coaching Interactions Inventory (CCII) was based on evidence of supervisor questioning techniques, the Tanner clinical judgment model, Bloom's Taxonomy, and simulation evaluation tools. Content validity was established with expert assessment, student testing for clarity, and calculation of scale–content validity index/average (S-CVI/Ave). Reliability was established with Kuder-Richardson Formula 20 (KR-20).

Results:

CVI (S-CVI/Ave) was .91, and KR-20 was .70. The CCII identified differences in clinical coaching behaviors in university faculty supervisors and staff nurse preceptor supervisors.

Conclusion:

The CCII advances the measurement of clinical coaching interactions from qualitative to quantitative. Ultimately, results from use of this inventory may facilitate the design of prelicensure clinical coaching strategies that promote the improvement of students' clinical reasoning skill. [J Nurs Educ. 2016;55(9):495–504.]

Development of nursing students' clinical reasoning skill is a major goal of prelicensure nursing education. It is believed that discourse and meaningful feedback within the student–supervisor relationship during clinical education experiences influences the development of students' clinical reasoning skill (Benner, Sutphen, Leonard, & Day, 2010; Lave & Wenger, 1991). The Carnegie study (Benner et al., 2010) identified clinical coaching—the one-to-one verbal teaching, questioning, and feedback behaviors used by a clinical supervisor with a student situated in the patient care context—as a signature pedagogy in nursing education. Recent findings show that clinical coaching interactions between school of nursing faculty supervisors and students in the clinical learning environment (CLE) are primarily characterized by remembering and understanding level questions that fail to engage students in the higher order thinking skills believed to promote clinical reasoning (McNelis et al., 2014). Protected time for one-to-one student–supervisor interactions during clinical experiences is often limited by pedagogy that focuses on task completion, rather than on the ability to reason through complex patient situations, as the measure of student competence (Benner et al., 2010; McNelis et al., 2014) .

Because new graduate nurses are expected to enter the work-force with the reasoning skills to navigate complex patient situations, students must have the opportunity to engage in learning that requires them to reason in the same manner required in the practice environment. Clinical coaching provides a framework for the engagement of students in the deliberate practice of reasoning skills and the provision of feedback on that practice, and is particularly important for helping students to notice and respond appropriately to changing patient situations. Coaching students to use thinking characterized by application, analysis, evaluation, creating, and reflecting, coupled with in-time feedback provided during or just after the clinical encounter that is specific about how to improve, promotes learning and the incorporation of newly acquired skills into future practice (Clynes & Raftery, 2008; Ericsson, 2004). Often, feedback is not consistently provided during clinical experiences but instead is provided long after the clinical encounter or is not specific enough to facilitate learning (McNelis et al., 2014). Further, feedback provided in a supportive manner contributes to increased student self-efficacy for clinical practice (van de Riddler, Peters, Stokking, de Ru, & Ten Cate, 2015). To promote improvement in students' clinical reasoning skill, clinical education pedagogy must prioritize strategies that promote discourse, part of which may include coaching, which is situated—pointing out and discussing salient aspects of a situation and providing corrective feedback in a supportive manner during or just after an encounter.

Currently, no instruments exist that describe or quantify the clinical coaching behaviors of clinical supervisors or to facilitate student reports of experiences with those coaching behaviors. Qualitative studies using observation and interview of school of nursing faculty clinical supervisors (McNelis et al., 2014) and students (Ironside, McNelis, & Ebright, 2014) provide the initial data to support the need for the advancement of measurement of clinical coaching behaviors.

Purpose

The purpose of this study was to develop an instrument to describe and quantify the construct of clinical coaching, defined as the one-to-one teaching, verbal questioning, and feedback behaviors used by a clinical supervisor (i.e., school of nursing faculty or staff nurse preceptor) with a student in the context of patient care situations to promote student identification of salient aspects of nursing practice. The instrument was designed to provide an initial quantitative understanding of teaching, questioning, and feedback characteristics used by school of nursing faculty and staff nurse preceptors during one-to-one clinical coaching interactions with students in the CLE. The instrument assists students in identifying (a) the teaching behaviors and levels of questioning used by their clinical supervisors and (b) the characteristics of feedback provided by their clinical supervisors during student–supervisor clinical coaching interactions.

Literature Review

Coaching is often characterized as a collaborative effort between a skillful coach and an individual or team to achieve specific outcomes, typically in a game or sport situation (International Coach Federation [ICF], 2015). The individual or team sets goals based on personal improvement desires and expectations of the game (ICF, 2015). The role of the coach is to facilitate individual team members' identification of areas for growth, to design practice to achieve specific improvement, and to provide feedback during that practice that enables the team member to incorporate specific behavior changes into subsequent practice. Coaching as a teaching strategy has been used successfully in leadership (Batson & Yoder, 2012), nursing practice (Duff, 2013), patient education (Vincent & Sanchez Birkhead, 2013), and clinical education for promoting student understanding of content and implementation of the nursing process (Grealish, 2000; Price, 2009). Coaching that includes teaching, questioning, and feedback that facilitates student awareness of their knowledge level and how to improve the use of that knowledge in specific situations (Bransford, Brown, & Cocking, 2000) offers a solid framework for guiding students' reasoning processes as clinical situations unfold.

Skillful clinical reasoning requires that an individual consider multiple self, patient, and situation factors to make a sound judgment (Tanner, 2006). The CLE provides multiple opportunities for honing clinical reasoning skill (Benner et al., 2010; Tanner, 2006). However, these opportunities may be lost if the primary focus of learning is on task completion, as opposed to the exploration of students' thought processes around the nuances of individual situations and subtle distinctions among multiple similar situations. Accurate and timely task completion may be perceived by clinical supervisors and students as a mechanism for ensuring patient safety. Rather, it is the completion of tasks and the accompanying understanding of the meaning of those tasks within the full context of the patient situation that contributes to maintenance of patient safety and improvement in patient outcomes (Benner et al., 2010). It is understood that the use of higher order cognitive questioning as a teaching– learning strategy promotes deeper learning (Anderson et al., 2001). In nursing, analysis and synthesis of knowledge, past experience, and situation-specific data is essential to making sound judgments regarding complex patient care situations (Tanner, 2006). Although knowledge and understanding are foundational to nursing practice, without the ability to apply knowledge to specific situations, analyze subtle distinctions in patient situations, and evaluate possible interventions appropriate for that situation, students lack the skill to take action that promotes positive patient outcomes.

Research by McNelis et al. (2014) has shown that student– supervisor interactions during clinical experiences tend to focus on task completion, as opposed to discussion of the complexities of patient care (McNelis et al., 2014). Helping students to learn about qualitative distinctions among complex patients was notably absent (McNelis et al., 2014). In addition, purposeful discourse focused on application of knowledge learned in the classroom setting to specific patient situations was also absent (McNelis et al., 2014).

Effective clinical coaching should include collaboration between the supervisor and student to identify the individual student's strengths and areas in need of improvement, as well as specific questioning and discussion to engage students in the analysis of data, consideration of alternative responses, and sound decisions based on those identified areas (Benner et al., 2010; International Coach Federation, 2007). In addition, feedback on the students' knowledge, interpretation of the situation, and on the decisions and actions taken should be given during or just after the encounter to provide the student with specific guidance on how to improve (Tanner, 2006). Thus, clinical coaching may facilitate focus on the higher order thinking skills needed to accurately reason through patient situations.

Method

Approval for this study was obtained by the institutional review boards of the participating universities. A convenience sample of 220 senior-level prelicensure nursing students (80 traditional baccalaureate nursing [BSN] students and 140 accelerated baccalaureate-equivalent master of science in nursing [MSN] students) was invited to participate.

The Clinical Coaching Interactions Inventory (CCII) was designed to describe the characteristics of the student–supervisor interaction in the clinical setting along two important dimensions of clinical coaching:

  • Teaching–questioning: the type and quantity of teaching and questioning strategies used.
  • Feedback: the qualities of feedback provided on student performance.

Initial development of the CCII was based on a previous qualitative study of the types of questioning used by clinical supervisors during clinical coaching interactions (McNelis et al., 2014), the theoretical foundation of the Tanner clinical judgment model (Tanner, 2006), Bloom's Taxonomy (Anderson et al., 2001), and validated simulation evaluation tools (Hayden, Keegan, Kardong-Edgren, & Smiley, 2014; Lasater, 2011). In addition, development of the inventory was focused on promoting students' ability to discern the variety of types of teaching, questioning, and feedback behaviors occurring during one-to-one clinical coaching interactions with their supervisor during clinical experiences. The 20 items were developed in three areas:

  • Number of one-to-one clinical coaching interactions experienced on the most recent clinical day and the perception of how that number of interactions affected their learning (four items).
  • Identification of the range and most representative types of teaching and questioning behaviors during those interactions (10 items).
  • Qualities of feedback provided during that clinical day (six items).

Teaching–Questioning Dimension

The items and corresponding example questions in the teaching–questioning dimension were based on the common clinical teaching strategies of providing information, demonstrating nursing skills, and role-modeling professional behaviors, as well as five categories of questions derived from the literature: task completion, remembering with definition, analysis of situation-specific data, synthesis of multiple types of data, and reflection on thinking and decisions (Anderson et al., 2001; Tanner, 2006). Examples of remembering, understanding, analyzing, evaluating or creating, and reflective questions were provided to facilitate student differentiation among levels of questions posed to them by their clinical supervisors.

Feedback Dimension

The six items in the feedback dimension were constructed to facilitate student identification of when feedback was given, how often the feedback occurred, how it made the students feel about their ability to be successful, and whether they felt it was sufficient to facilitate their learning.

Scoring

Binary structure of items facilitated the identification of the range and most representative types of teaching, questioning, and feedback behaviors demonstrated by clinical instructors. Students answered yes or no to indicate whether their clinical supervisor demonstrated each type of teaching, questioning, or feedback behavior. In addition, students were asked to identify the most representative and second-most representative type of teaching or questioning behaviors demonstrated by their clinical supervisor. Further investigation is necessary to determine whether a calculation of a total score will provide valuable structure for analysis over simple description of behaviors.

Validity

A priori content validity was established through evidence-based construct definition and analysis of the dimensions of clinical teaching–questioning and feedback within the prelicensure CLE. Posteriori content validity was established with expert assessment (Lynn, 1986). Six experienced school of nursing faculty clinical supervisors, each with more than 10 years of experience engaging in one-to-one interactions with students in the CLE, were invited to review the items for relevance, content accuracy, and wording. Items were evaluated on a 4-point ordinal scale, in which 1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = highly relevant. Ratings were evaluated by examining the number of faculty rating items as relevant to one-to-one clinical coaching interactions. Initially, the range of item–content validity index (I-CVI) for items was .60 to 1.0. The one item below .80 resulted in clarification wording of the construct definition that improved the relevance of the item to .80.

A second round of expert review resulted in a .80 to 1.0 range of I-CVI. Subsequently, the scale–content validity index/average (S-CVI/Ave) was calculated by summing the I-CVIs and dividing by the number of items and was determined to be .91. Given that the S-CVI/Ave was above the recommended criterion for acceptability of .90 (Polit & Beck, 2006), the content validity of the inventory was determined to be acceptable. Further, students who had recently completed prelicensure nursing education and had recently experienced one-to-one clinical coaching interactions with school of nursing faculty and staff nurse preceptor supervisors in the CLE were invited to evaluate the tool for ease of use and item clarity. The five-person student sample completed the tool on the basis of their experience on a recent clinical day and rated the items for clarity. Individual ratings were followed by a discussion to determine students' ability to discern the distinctions between the levels of questions. The final inventory consisted of 17 items that were divided into three sections: number of interactions with clinical instructor, description of teaching– coaching behaviors demonstrated by the clinical supervisor, and description of feedback received from the clinical supervisor.

Reliability

The teaching-questioning dimension demonstrated a Kuder-Richardson Formula 20 (KR-20) of .70 overall, .63 for the faculty version, and .71 for the staff nurse preceptor version. The feedback dimension demonstrated a KR-20 of .70 overall, .53 for the faculty version, and .57 for the staff nurse preceptor version. The inventory is composed of a minimal number of binary items and therefore a lower KR-20 is not unexpected. Further, this inventory facilitates student report of supervisor clinical coaching behaviors, which will be different and thus elicit different student responses on items. As a result, the use of measures of repeatability of individual test performance should not be the primary evaluation of overall reliability of this tool (Sijtsma, 2009). Further, the array of items in the inventory provides essential coverage of the teaching– questioning and feedback domains of clinical coaching that supports use of the measure, despite lower internal consistency values (Schmitt, 1996).

Results

Participants

The final sample consisted of 135 senior-level prelicensure nursing students (100% of the total sample): 53 traditional BSN students who experienced supervision by only a staff nurse preceptor or collaborative supervision by a staff nurse preceptor and a university faculty member, some of whom had been educated in a dedicated education unit (DEU); and 82 accelerated baccalaureate-equivalent MSN students who experienced supervision by only a university faculty member or collaborative supervision by a staff nurse preceptor and a university faculty member, all of whom had been educated in a non-DEU. This variety in type of clinical supervisor and type of CLE provided the opportunity to discern similarities and differences in clinical coaching behaviors in those supervisors and CLEs. The accelerated baccalaureate-equivalent MSN students were asked to complete the index only once after the completion of one third of their final medical– surgical clinical experience. The students in the traditional BSN program were asked to complete the index two additional times, after the completion of two thirds of their final medical–surgical clinical experience and at the end of their final medical–surgical clinical experience. The accelerated baccalaureate-equivalent MSN students' clinical experience was compressed into 4 weeks; thus, to decrease the burden of study participation, those students were asked to complete the index only once, after completion of one third of their final medical–surgical experience.

Students Completing the Index After One Third of the Clinical Experience

Of all students who completed the index after completion of one third of their clinical experience (N = 143) (Table 1), 41% of students who experienced any supervision by a school of nursing faculty (n = 85) and 55% of students experiencing any supervision by a staff nurse preceptor (n = 58) reported having five or more one-to-one interactions with that supervisor during the course of the most recent clinical day. The majority of students perceived the number of interactions they had with their supervisor as just enough to facilitate their learning. The teaching–questioning behaviors of both types of supervisors varied, with the majority of students reporting being asked a wide variety of question types that ranged from knowledge to synthesis level. Students reported that the most representative types of teaching–questioning they received from their school of nursing faculty were analysis- or synthesis-level questions, whereas staff nurse preceptors most often gave instructions about how to provide care and demonstrated nursing skills.


Completed by Participants at One Third Completion of Clinical Rotation (N = 143)
Completed by Participants at One Third Completion of Clinical Rotation (N = 143)

Table 1:

Completed by Participants at One Third Completion of Clinical Rotation (N = 143)

The majority of students reported receiving verbal feedback from their supervisor and that the feedback was given in a way that made them feel supported. Seventy percent of students reported that verbal feedback was given during or soon after a patient encounter by the school of nursing faculty, and 88% of students said the same about the staff nurse preceptor. More than half of all students reported that the verbal feedback they received was very specific about how to improve, whereas another third reported feedback as helpful but not specific about how to improve. The majority of students reported receiving feedback about their delivery of nursing care, whereas slightly more than one third reported receiving feedback on their level of knowledge, skill performance, and communication with members of the health care team. Forty-eight percent of students reported receiving feedback on decisions made about patient care from their school of nursing faculty, but only 26% of students reported receiving the same from a staff nurse preceptor.

Students Completing the Index Three Times (N = 53)

Of the students who experienced any supervision by a staff nurse preceptor (n = 34) (Table 2), slightly more than one third reported having five or more one-to-one interactions with that preceptor at each time point, with the majority of others reporting three to four interactions at each time point. Of the students who experienced any supervision by a university faculty (n = 20), the majority reported having none or only one to two interactions with that supervisor at each time point. The majority of students perceived the number of interactions they had with both types of supervisors as just enough to facilitate their learning. Although students reported a wide variety of teaching–questioning behaviors from both types of supervisors, the most representative types of teaching–questioning received from university faculty at all time points were analysis- or synthesis-level questions. Staff nurse preceptors used an equally distributed frequency of giving instructions, demonstrating nursing skills, and using a variety of question types across all time points.


Completed by Participants at One Third, Two Thirds, and Full Completion of Clinical Rotation (N = 53)
Completed by Participants at One Third, Two Thirds, and Full Completion of Clinical Rotation (N = 53)
Completed by Participants at One Third, Two Thirds, and Full Completion of Clinical Rotation (N = 53)

Table 2:

Completed by Participants at One Third, Two Thirds, and Full Completion of Clinical Rotation (N = 53)

At each time point and for both types of supervisors, the majority of students reported receiving verbal feedback that was given during or soon after a patient encounter and was given in a way that made them feel supported. Feedback provided by university faculty was perceived as very specific about how to improve by 46% of students at time 1, 100% at time 2, and 73% at time 3. Feedback provided by staff nurse preceptors was perceived as very specific about how to improve by 73% of students at time 1, and 65% at both time 2 and time 3. Both types of supervisors provided feedback on a variety of topics, but the majority of the students received feedback primarily on their responses to supervisor questions and delivery of nursing care, regardless of the type of supervisor.

Discussion

In the sample of students who completed the index multiple times, a marked difference was found in the number of interactions reported with the university clinical instructor versus the staff nurse preceptor. This likely reflects that all of the students in this group were supervised by only a staff nurse preceptor but still had a university faculty assigned to oversee that supervision or that they were supervised in a collaborative manner by both a staff nurse preceptor and a university faculty in a DEU. It is unknown whether a specific guideline existed for frequency or type of interaction between the university faculty and students or staff nurse preceptors.

Students in this study reported that university clinical instructors most often used questioning at the analysis and synthesis levels, whereas staff nurse preceptors most often demonstrated skills or gave directions about how to provide care. Conversely, McNelis et al. (2014) observed that the university clinical instructors primarily used task- and knowledge-focused questions during clinical coaching interactions. Because education is the primary role of university clinical instructors, questioning at the analysis and synthesis levels could be expected. It is possible that the different groups of university clinical instructors in these two studies were trained differently in clinical education teaching strategies, including clinical coaching as defined in this study, and that the results identify actual differences. However, although efforts were made to facilitate students' ability to accurately report the teaching–questioning and feedback behaviors experienced in clinical coaching interactions, their reports may not reflect actual occurrences. The finding that demonstration and providing directions were some of the primary coaching behaviors of staff nurse preceptors is congruent with their primary role of patient care. This may be attributed to the limited capacity of staff nurse preceptors to teach due to patient care load or a lack of training in clinical teaching–questioning and feedback skills (Henderson, Twentyman, Heel, & Lloyd, 2006; Luhanga, Billay, Grundy, Myrick, & Yonge, 2010; McClure & Black, 2013). However, some students completing the index at multiple time points reported more analysis, synthesis, and reflective levels of questions by staff nurse preceptors, which could be due to increased education on clinical teaching pedagogy provided for staff nurses in the DEU (Mulready-Shick, Kafel, Banister, & Mylott, 2009; Rhodes, Meyers, & Underhill, 2012).

Students reported that most feedback by both university faculty and staff nurse preceptors was provided during or immediately after the patient encounter and often included specific feedback about the students' level of knowledge and performance of psychomotor skills. The group of students who completed the index multiple times reported receiving feedback on decisions made about patient care more often by staff nurse preceptors than by university faculty at all time points. This is not unexpected, given that the staff nurse preceptor was the primary instructor in this group of students and that the university faculty was likely not present for most of the encounters in which decisions were made.

Recommendations for Future Study

The current use of the CCII sampled only senior-level students, described the clinical coaching behaviors of supervisors on one clinical day, and compared student reports of interactions with the same supervisor on multiple clinical days. Future studies should examine whether differences exist in clinical coaching behaviors used with students at various times during the nursing program and how those differences contribute to student learning at those particular times. Although examples of each type of teaching and questioning were provided to facilitate accurate student reporting of clinical coaching behaviors, comparison of student ratings with observation of actual clinical coaching behaviors for congruence would further validate the instrument. Results from use of this inventory may identify the need for further education in university faculty and staff nurse preceptors and provide guidance for the development and implementation of education to improve their ability to engage students in the higher order thinking known to promote clinical reasoning.

Conclusion

The CCII advances the measurement of clinical coaching interactions from qualitative to quantitative and provides users with the ability to quantify and characterize the clinical coaching interactions that occur in prelicensure clinical education in nursing. The identified differences in clinical coaching behaviors in university faculty supervisors and staff nurse preceptor supervisors warrants further investigation to determine how those differences affect student learning outcomes. Ultimately, results from use of this inventory may facilitate the design of prelicensure clinical coaching strategies that promote the improvement of students' clinical reasoning skills.

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Completed by Participants at One Third Completion of Clinical Rotation (N = 143)

Characteristics of One-to-One Interactions With Supervisor During Most Recent Clinical Day% of Students Reporting Some Supervision by a University Clinical Instructor (n = 85)% of Students Reporting Some Supervision by a Staff Nurse Preceptor (n = 58)
Number of interactionsa
  None829.3
  1 to 214.45.2
  3 to 420.710.3
  ⩾541.455.2
Perception of number of interactions
  Too few2.45.2
  Just enough94.184.5
  Too many, did not interfere with learning3.58.6
  Too many, did interfere with learning01.7
Characteristics of interactions with supervisorb
  Gave instructions on actions to take36.989.3
  Asked task-focused questions71.881.8
  Asked knowledge questions92.968.4
  Demonstrated skills70.686
  Role modeled professional practice77.685.7
  Asked analysis questions83.573.2
  Asked synthesis questions8058.9
  Asked reflective questions81.251.8
Most representative action by supervisor
  Gave instructions022.8
  Asked task-focused questions9.68.8
  Asked knowledge-focused questions10.75.3
  Demonstrated skills9.515.8
  Role modeled professional practice7.115.8
  Asked analysis questions2515.8
  Asked synthesis questions29.812.3
  Asked reflective questions8.33.5
Second most representative characteristic of interactions
  Gave instructions4.81.9
  Task-focused questions7.113.2
  Knowledge-focused questions10.75.7
  Demonstrated skills10.734
  Role modeled professional practice10.79.4
  Analysis questions16.713.2
  Synthesis questions21.415.1
  Reflective questions17.97.5
Analysis or synthesis reported as one of most representative characteristics70.243.9
Characteristics of verbal feedback given by supervisorb
  Any verbal feedback87.184.2
  Feedback given during or just after interaction70.588.2
  Feedback given at end of day29.511.8
  Feedback given in a way that was supportive93.696
  Feedback given in a way that was discouraging6.44
  Feedback was too general to be helpful7.75.9
  Feedback was helpful, but not specific34.631.4
  Feedback was very specific about how to improve57.762.7
Topics on which feedback was providedb
  Responses to instructor questions87.184.2
  Knowledge level47.156.9
  Delivery of nursing care86.987.7
  Psychomotor skill level57.665.5
  Communication with others49.446.6
  Decisions made63.526.1

Completed by Participants at One Third, Two Thirds, and Full Completion of Clinical Rotation (N = 53)

Characteristics of One-to-One Interactions With Supervisor During Most Recent Clinical DayAttempt 1Attempt 2Attempt 3



% of Students Reporting Some Supervision by a University Clinical Instructor (n = 20)% of Students Reporting Some Supervision by a Staff Nurse Preceptor (n = 34)% of Students Reporting Some Supervision by a University Clinical Instructor (n = 12)% of Students Reporting Some Supervision by a Staff Nurse Preceptor (n = 21)% of Students Reporting Some Supervision by a University Clinical Instructor (n = 16)% of Students Reporting Some Supervision by a Staff Nurse Preceptor (n = 21)
Number of interactionsa
  None40066.70250
  1 to 23512.133.3062.59.5
  3 to 4042.4057.1052.4
  ⩾52545.5042.912.538.1
Perception of number of interactions
  Too few8.32.904.800
  Just enough91.785.31008110081
  Too many, did not interfere with learning08.8014.3014.3
  Too many, did interfere with learning02.90004.8
Characteristics of interactions with supervisora
  Gave instructions on actions to take41.790.92585.733.390.5
  Asked task-focused questions41.787.5255095.2
  Asked knowledge questions90.978.875817576.2
  Demonstrated skills58.393.92590.541.785.7
  Role modeled professional practice5090.92510066.7100
  Asked analysis questions91.787.9258158.381
  Asked synthesis questions66.772.75076.283.381
  Asked reflective questions7563.67561.983.371.4
Most representative action by supervisor
  Gave instructions018.2015014.3
  Asked task-focused questions16.76.12508.30
  Asked knowledge-focused questions8.33251516.79.5
  Demonstrated skills018.20158.39.5
  Role modeled professional practice16.715.202516.723.8
  Asked analysis questions33.315.20158.328.6
  Asked synthesis questions2518.250152514.3
  Asked reflective questions06.10016.70
Second most representative characteristic of interactions
  Gave instructions8.33.4255.316.75.6
  Task-focused questions8.313.8015.816.711.1
  Knowledge-focused questions16.73.42510.58.316.7
  Demonstrated skills8.300000
  Role modeled professional practice010.3255.38.35.6
  Analysis questions16.720.7015.816.716.7
  Synthesis questions2513.8015.816.722.2
  Reflective questions16.734.52531.616.722.2
Analysis or synthesis reported as one of most representative characteristics7551.55047.65052.4
Characteristics of verbal feedback given by supervisora
  Any verbal feedback91.797.15095.293.895.2
  Feedback given during or just after interaction72.793.910010081.890
  Feedback given at end of day27.36.10018.210
  Feedback given in a way that was supportive81.81001009010095
  Feedback given in a way that was discouraging18.2001005
  Feedback was too general to be helpful18.2001000
  Feedback was helpful, but not specific36.427.302527.335
  Feedback was very specific about how to improve45.572.71006572.765
Topics on which feedback was provideda
  Responses to instructor questions83.3975090.583.390.5
  Knowledge level5061.85061.941.742.9
  Delivery of nursing care83.3975095.27595.2
  Psychomotor skill level33.367.65071.458.371.4
  Communication with others33.347.12552.458.371.4
  Decisions made33.355.92561.933.357.1
Authors

Dr. Jessee is Assistant Professor and Prespecialty Level Director, Vanderbilt University School of Nursing, Nashville, Tennessee; and Dr. Tanner is Professor Emerita, Oregon Health & Science University, Portland, Oregon.

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

Address correspondence to Mary Ann Jessee, PhD, RN, Assistant Professor and Prespecialty Level Director, Vanderbilt University School of Nursing, Nashville, TN 37240; e-mail: Mary.a.jessee@vanderbilt.edu.

Received: January 22, 2016
Accepted: May 18, 2016

10.3928/01484834-20160816-03

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