Florence Myrick

A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy

SUMMARY The use of high-fidelity human patient simulators (HPS) have been embraced by nursing education programs in the development of immersive clinical simulations despite the lack of research into a pedagogy or educational philosophy appropriate to guide this technology-based learning tool. In this article, we explore this approach to clinical teaching through a critical examination of the application of behaviorist and constructivist pedagogy to high-fidelity scenario-based simulation sessions. Practical guidelines for developing simulation-based learning sessions that reflect both philosophical paradigms are provided. Consideration is also given to societal trends such as the digital revolution and the incoming millennial generation who represent the aptitude of the modern nursing student to utilize high-fidelity realistic and immersive simulation. Depending on the desired goal of simulator utilization, the nurse educator may want to draw on constructivism or behaviorism or a blend of both educational philosophies to best meet the needs of the adult learner.

Preceptorship and Critical Thinking in Nursing Education.

Although preceptorship is being used increasingly by nursing faculty in the practice setting, little is known about how preceptors teach and even less is known about how critical thinking is being fostered in that relationship. The purpose of this study was to examine the process used in preceptorship to develop and promote the critical thinking ability of baccalaureate nursing students. Using the grounded theory method, this study was conducted in a large tertiary care hospital. Participants included fourth-year baccalaureate nursing students (preceptees) and their staff nurse preceptors. Data collection was composed of semistructured interviews and observations of the preceptors and preceptees as they worked together in the practice setting. Secondary data sources included documents considered appropriate to the study (e.g., nurse notes, student journals). By constant comparative analysis of the data, the findings of this study revealed a process that reflects the enabling of students by preceptors to develop and promote their critical thinking ability in the practice setting.

The Prevailing Winds of Oppression: Understanding the New Graduate Experience in Acute Care

TOPIC The experience of new graduates in acute care. PURPOSE The majority of newly graduated nurses make their initial professional role transition in acute care. Being socialized into the dynamic culture of todays hospitals creates significant challenges not only for the nurses themselves but also for institutions of higher education, healthcare administrators, and policy makers across this country. Demanding workloads for hospital nurses, an aging nursing workforce, and the high level of stress inherent in workplaces across North America are factors contributing to an exodus of both new and seasoned nurses out of acute care. This article outlines the implicit and explicit factors that may be contributing to the dissatisfaction and distress in nursing graduates entering professional practice through hospital nursing. SOURCES OF INFORMATION CINAHL, MEDLINE, Sociolit, and PubMed. CONCLUSION Discussion is focused on the oppressive context in which hospital nursing continues to be situated and explores the ideological, structural, and relational aspects of domination that continue to surface in the work experiences of novice as well as seasoned nurses. Suggestions for addressing the issues that plague the acute care environment are integrated throughout the article, and a detailed framework of empowerment for this nursing context is offered.

Preceptorship and mentorship: not merely a matter of semantics

In academic writing on mentoring and preceptorship there is little consensus on the meaning or characteristics surrounding these terms. The writers of this paper contend that the correct usage of preceptorship and mentorship, which gives credence and respect to the very different concepts embedded in each, is a very important precursor to the evolution of these two concepts in nursing education, both academically and within practical application. Although language is continually changing, lack of clarity robs language of its richness and complexity and interferes with clear thinking about the issues. In professional terms, clarity demands that concepts, around which a body of knowledge is growing, be consistent in their meaning and characteristics. Such clarity between the related educational concepts of mentor(ship) and preceptor(ship) is lacking.

Preceptor behaviors integral to the promotion of student critical thinking.

In the practice setting, preceptors not only contribute to the relational aspect of the preceptorship experience but, through their behaviors, they also effectively promote the critical thinking ability of students. Through the use of a grounded theory method in a recent study, four specific preceptor-generated behaviors were identified as integral to the promotion of the critical thinking ability of basic baccalaureate nursing students in the practice setting: role modeling, facilitation, guidance, and prioritization. In this article, the description and meaning of these four behaviors are explored and their significance to preceptors and nurse educators who wish to ensure that the critical thinking ability of nursing students is fostered in the practice setting is discussed.

Transformative learning as a context for human patient simulation.

Nurse educators are charged with the responsibility of empowering novice nurses to become autonomous thinkers with the capacity to cope with the many challenges of modern day practice. Human patient simulation is a powerful technology-based educational tool ideally suited for the application of emancipatory pedagogies that aid in the transformation of individual meaning schemes. Transformative learning theory provides educators with the tools to empower students to challenge their preconceived beliefs, assumptions, and values and socialize them appropriately to thrive in modern day clinical practice. The purpose of this article is to critically analyze the role of clinical scenarios using human patient simulation to promote transformative learning events in undergraduate nursing education. The authors focus on the role of debriefing in the promotion of the critical reflection and social discourse that is integral to the learning process and the implementation of scenarios that provide students with disorientating dilemmas for perspective transformation.

Failure to assign failing grades: issues with grading the unsafe student

In a grounded theory study examining the process of precepting an unsafe student, it was found that preceptors assigned passing grades to students who in fact should not have passed. Although preceptors perceived their role as gatekeepers for the profession, by not assigning failing grades to students who should not have passed a course, essentially they were abdicating their responsibility. Indeed, the simple act of assuming responsibility for precepting a student implies professional as well as pedagogical accountability.

Student Nurse Stress in the Preceptorship Experience

Student nurses appear to experience significantly more stress during their academic preparation than they do during the first year of employment. Preceptorship is among the most stressful of student experiences. It is within the context of a challenging and at times daunting work environment that two complete strangers (preceptor and student) strive to accommodate one another within a professional capacity. If the relationship between preceptor and student is less than successful, not only can it be frustrating and disheartening, but it can result in student stress and disillusionment about nursing and an inability to integrate and learn. Using a hypothetical case, the authors discuss the importance of student assessment, close communication between faculty and preceptors, and quick responses to student stress as a means by which to circumvent the serious potential of student burnout in the practice setting.

Preceptorship and practical wisdom: A process of engaging in authentic nursing practice.

Preceptorship is a teaching/learning approach, in which learners are individually assigned to staff nurses in the practice setting. Practical wisdom is a discerning process of evaluating and applying ideals or principles often in a moral context. The nurse who is practically wise recognizes that actions are always constrained to some extent by chance or context and yet precisely under such circumstances, acts to preserve and enhance the wellbeing of the patient. The purpose of this study was to examine the process used in the preceptorship experience to nurture practical wisdom. A grounded theory study was conducted with fourth year undergraduate nursing students and their preceptors in an acute/tertiary care setting. Data collection comprised a series of semi-structured interviews, documentation of field notes and journaling. Findings reveal that preceptors who nurture practical wisdom in the practice setting do so by engaging in a process of authentic nursing practice.

Meeting the challenge of new graduate role transition: clinical nurse educators leading the change.

The transition from new graduate to professional nurse can be a challenging process. In some cases, more than 50% of new graduates have left their first position within the first year. One strategy that has been shown to yield positive results in facilitating new graduate role transition is nurse internship programs. All studies of internship programs in this review demonstrated lower turnover at 1 year after hire when compared with traditional clinical orientation programs.